Healthcare Provider Details

I. General information

NPI: 1760550180
Provider Name (Legal Business Name): BRIAN E DAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WEST 3RD ST
PALISADE CO
81526
US

IV. Provider business mailing address

720 36 1/10 RD
PALISADE CO
81526-9744
US

V. Phone/Fax

Practice location:
  • Phone: 970-464-5123
  • Fax:
Mailing address:
  • Phone: 970-464-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7180
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: