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General NPI Number Information
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NPI Number | 1477911758
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Entity Type | Organization
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Legal Business Name | OPEN AND AFFORDABLE DENTAL AT BRIGHTON
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 1790 E BRIDGE ST
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City | BRIGHTON
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State | CO
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Zip | 80601-1934
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Country | US
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Telephone | 303-644-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 1790 E BRIDGE ST
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City | BRIGHTON
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State | CO
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Zip | 80601-1934
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Country | US
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Telephone | 303-644-5058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON STOTT
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Credential | D.D.S.
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Telephone | 303-644-5058
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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 | DEN.00202024
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License Number State | CO
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