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General NPI Number Information
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NPI Number | 1851962310
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Entity Type | Organization
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Legal Business Name | PEDODENT PC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 2700 E BRIDGE ST
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City | BRIGHTON
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State | CO
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Zip | 80601-2591
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Country | US
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Telephone | 303-659-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 8723 WADSWORTH BLVD STE B
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City | ARVADA
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State | CO
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Zip | 80003-0921
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Country | US
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Telephone | 303-422-6752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN NELSON
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Credential |
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Telephone | 303-422-6752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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