Provider Demographics
NPI:1245470350
Name:SHELBY L. KAHL RDH, PC
Entity type:Organization
Organization Name:SHELBY L. KAHL RDH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, RMT, CCP
Authorized Official - Phone:970-686-6899
Mailing Address - Street 1:1194 W ASH ST STE E
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4608
Mailing Address - Country:US
Mailing Address - Phone:970-686-6899
Mailing Address - Fax:970-686-0889
Practice Address - Street 1:1194 W ASH ST STE E
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4608
Practice Address - Country:US
Practice Address - Phone:970-686-6899
Practice Address - Fax:970-686-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1848124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1578772851OtherNPI
CO43558232Medicaid