Healthcare Provider Details

I. General information

NPI: 1205626686
Provider Name (Legal Business Name): ELYSE RENATE BRUEGGEMANN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 23RD ST STE 202
GLENWOOD SPRINGS CO
81601-4384
US

IV. Provider business mailing address

401 23RD ST STE 202
GLENWOOD SPRINGS CO
81601-4384
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-8753
  • Fax:
Mailing address:
  • Phone: 970-945-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00206606
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: