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General NPI Number Information
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NPI Number | 1245887488
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Entity Type | Organization
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Legal Business Name | KYLEE BRIGHTSIDE DDS PLLC
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 1161 S PERRY ST STE B100
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City | CASTLE ROCK
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State | CO
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Zip | 80104-1978
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Country | US
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Telephone | 720-799-1445
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 S PERRY ST STE B100
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City | CASTLE ROCK
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State | CO
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Zip | 80104-1978
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Country | US
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Telephone | 720-799-1445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLEE BRIGHTSIDE
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Credential | DDS
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Telephone | 720-799-1445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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