Healthcare Provider Details

I. General information

NPI: 1740440205
Provider Name (Legal Business Name): KELLOGG-PAISLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E BROMLEY LN SUITE 201
BRIGHTON CO
80601-7820
US

IV. Provider business mailing address

4700 E BROMLEY LN SUITE 201
BRIGHTON CO
80601-7820
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-0667
  • Fax: 303-659-5247
Mailing address:
  • Phone: 303-659-0667
  • Fax: 303-659-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8690
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8744
License Number StateCO

VIII. Authorized Official

Name: DR. BRADLEY SCOTT KELLOGG
Title or Position: DENTIST/MANAGER
Credential: DDS
Phone: 303-659-0667