Healthcare Provider Details

I. General information

NPI: 1154692051
Provider Name (Legal Business Name): BRANDON D VISSCHER DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 COLE BLVD SUITE 140
LAKEWOOD CO
80401-3213
US

IV. Provider business mailing address

1726 COLE BLVD SUITE 140
LAKEWOOD CO
80401-3213
US

V. Phone/Fax

Practice location:
  • Phone: 303-279-6929
  • Fax: 303-279-8907
Mailing address:
  • Phone: 303-279-6929
  • Fax: 303-279-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN A CRISPE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 303-279-6929