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General NPI Number Information
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NPI Number | 1063920379
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Entity Type | Organization
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Legal Business Name | BLISS DENTAL HEALTH, LLC
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Dates
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Enumeration Date | 01/21/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 9362 S COLORADO BLVD UNIT D14
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-5207
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Country | US
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Telephone | 720-608-9923
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Fax |
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Provider Business Mailing Address
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Address Line | 9615 E COUNTY LINE RD # B553
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City | CENTENNIAL
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State | CO
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Zip | 80112-3527
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Country | US
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Telephone | 720-608-9923
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Fax |
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Authorized Official
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Title or Position | OWNER/EMPLOYEE
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Name | MRS. BRANDI LYNN BRANDENBURG
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Credential | RDH, BSDH
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Telephone | 303-960-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.000905258
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License Number State | CO
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