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General NPI Number Information
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NPI Number | 1649426495
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Entity Type | Organization
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Legal Business Name | BNS LLC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 7520 BIERSTADT HTS SUITE 125
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City | PEYTON
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State | CO
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Zip | 80831-6174
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Country | US
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Telephone | 719-495-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 7520 BIERSTADT HTS SUITE 125
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City | PEYTON
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State | CO
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Zip | 80831-6174
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Country | US
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Telephone | 719-495-3131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAY BRANDON JOHNSON
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Credential | DMD
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Telephone | 719-495-3131
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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 | 9312
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License Number State | CO
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