Provider Demographics
NPI:1902322290
Name:KHL ENTERPRISES, PLLC
Entity Type:Organization
Organization Name:KHL ENTERPRISES, PLLC
Other - Org Name:STONEBROOK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-289-5867
Mailing Address - Street 1:667 RIDGEGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-2264
Mailing Address - Country:US
Mailing Address - Phone:720-289-5867
Mailing Address - Fax:
Practice Address - Street 1:14555 E ARAPAHOE RD UNIT D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1584
Practice Address - Country:US
Practice Address - Phone:303-766-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94804261Medicaid