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General NPI Number Information
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NPI Number | 1720475635
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Entity Type | Organization
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Legal Business Name | BRIAN L SECRIST DDS PC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 11401 WASHINGTON ST
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City | NORTHGLENN
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State | CO
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Zip | 80233-1912
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Country | US
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Telephone | 303-254-4444
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Fax | 303-254-6552
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Provider Business Mailing Address
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Address Line | 11401 WASHINGTON ST
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City | NORTHGLENN
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State | CO
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Zip | 80233-1912
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Country | US
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Telephone | 303-254-4444
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Fax | 303-254-6552
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. BRIAN L SECRIST
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Credential | DDS
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Telephone | 303-254-4444
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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 | 105294
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License Number State | CO
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