Healthcare Provider Details

I. General information

NPI: 1982822987
Provider Name (Legal Business Name): COLLIN BRONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 N CAREFREE CIR
COLORADO SPRINGS CO
80917-2795
US

IV. Provider business mailing address

5780 N CAREFREE CIR
COLORADO SPRINGS CO
80917-2795
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-9737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8263
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: