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General NPI Number Information
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NPI Number | 1952708877
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Entity Type | Organization
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Legal Business Name | EDWARD J. BERTAGNOLLI, DDS, PC
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 7280 BRADBURN BLVD.
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City | WESTMINSTER
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State | CO
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Zip | 80030
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Country | US
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Telephone | 303-429-6222
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Fax | 303-429-7247
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Provider Business Mailing Address
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Address Line | 7280 BRADBURN BLVD.
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City | WESTMINSTER
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State | CO
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Zip | 80030
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Country | US
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Telephone | 303-429-6222
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Fax | 303-429-7247
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Authorized Official
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Title or Position | DENTIST
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Name | JOHN O. BERTAGNOLLI
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Credential | DDS.
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Telephone | 303-429-6222
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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 | HDL00161
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License Number State | CO
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