Healthcare Provider Details

I. General information

NPI: 1003952516
Provider Name (Legal Business Name): DR. BRIAN FRUTCHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W SOUTH BOULDER RD UNIT 201
LOUISVILLE CO
80027-2417
US

IV. Provider business mailing address

850 W SOUTH BOULDER RD UNIT 201
LOUISVILLE CO
80027-2417
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-6120
  • Fax:
Mailing address:
  • Phone: 303-665-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8684
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: