Healthcare Provider Details

I. General information

NPI: 1295740603
Provider Name (Legal Business Name): BRIAN TODD PICKLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 BRIAR VILLAGE POINT SUITE 300
COLORADO SPRINGS CO
80920-7979
US

IV. Provider business mailing address

9480 BRIAR VILLAGE POINT SUITE 300
COLORADO SPRINGS CO
80920-7979
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-0670
  • Fax: 719-599-0613
Mailing address:
  • Phone: 719-599-0670
  • Fax: 719-599-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number7214
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7214
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: