Healthcare Provider Details

I. General information

NPI: 1851140024
Provider Name (Legal Business Name): BRIGHTON PEDO DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E BRIDGE ST STE 201
BRIGHTON CO
80601-2561
US

IV. Provider business mailing address

7999 S COUNTRY CLUB PKWY
AURORA CO
80016-1195
US

V. Phone/Fax

Practice location:
  • Phone: 720-277-5930
  • Fax: 303-330-0714
Mailing address:
  • Phone: 720-579-8855
  • Fax: 877-444-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: COLTON FLAKE
Title or Position: MANAGING PARTNER
Credential: DDS
Phone: 720-277-5930