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General NPI Number Information
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NPI Number | 1164936035
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Entity Type | Organization
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Legal Business Name | D SCOTT TOPHAM DDS PROFESSIONAL LLC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 1055 17TH AVE STE 202
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City | LONGMONT
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State | CO
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Zip | 80501-2647
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Country | US
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Telephone | 303-772-2611
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Fax | 303-772-5106
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Provider Business Mailing Address
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Address Line | 1055 17TH AVE STE 202
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City | LONGMONT
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State | CO
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Zip | 80501-2647
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Country | US
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Telephone | 303-772-2611
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Fax |
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. DAVID SCOTT TOPHAM
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Credential | DDS
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Telephone | 303-772-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10254
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License Number State | CO
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