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General NPI Number Information
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NPI Number | 1740440205
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Entity Type | Organization
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Legal Business Name | KELLOGG-PAISLEY LLC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 4700 E BROMLEY LN SUITE 201
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City | BRIGHTON
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State | CO
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Zip | 80601-7820
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Country | US
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Telephone | 303-659-0667
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Fax | 303-659-5247
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Provider Business Mailing Address
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Address Line | 4700 E BROMLEY LN SUITE 201
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City | BRIGHTON
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State | CO
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Zip | 80601-7820
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Country | US
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Telephone | 303-659-0667
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Fax | 303-659-5247
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Authorized Official
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Title or Position | DENTIST/MANAGER
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Name | DR. BRADLEY SCOTT KELLOGG
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Credential | DDS
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Telephone | 303-659-0667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8744
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8690
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License Number State | CO
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