Basic Information
| Provider Information | |||||||||
| NPI: | 1033200811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENDRESS | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 14710 W COLFAX AVE UNIT 150 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032790999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14710 W COLFAX AVE UNIT 150 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032790999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN.00204446 | CO | N | Dental Providers | Dentist | 1223G0001X | 60408 | KS | N | Dental Providers | Dentist | General Practice | 1223G0001X | DEN.00204446 | CO | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 200383350A | 05 | KS | MEDICAID | 116977 | 01 | KS | BCBS OF KS | OTHER |