Basic Information
| Provider Information | |||||||||
| NPI: | 1548457138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENTISH | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033843999 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033843999 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A101185 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 49099 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 53738870 | 05 | CO | MEDICAID |