Healthcare Provider Details

I. General information

NPI: 1679147565
Provider Name (Legal Business Name): BRIDGECREEK PROSTHETIC DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 E. HAMPDEN AVENUE SUITE C6
DENVER CO
80231-4930
US

IV. Provider business mailing address

8751 E. HAMPDEN AVENUE SUITE C6
DENVER CO
80231-4930
US

V. Phone/Fax

Practice location:
  • Phone: 303-755-4003
  • Fax: 303-743-9638
Mailing address:
  • Phone: 303-755-4003
  • Fax: 303-743-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: BRIAN COIT BUTLER
Title or Position: OWNER-PARTNER-DENTISTPROSTHODONTIST
Credential: DDS, MS
Phone: 303-755-4003