MEDICARE: ELK RIDGE DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	202462	CO
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1194247510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK RIDGE DENTISTRY

Provider Business Mailing Address
First Line	:	131 STANLEY AVE STE 201
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6356
Country	:	US
Telephone Number	:	970-586-5657
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 STANLEY AVE STE 201
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-6356
Country	:	US
Telephone Number	:	970-586-5657
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAD R BROWN
Credential	:	DDS
Telephone Number	:	970-586-5657

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/21/2022

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Directions to “ELK RIDGE DENTISTRY ” Practice Location

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