MEDICARE: BRYLIE BUTTON

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	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1215542576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYLIE BUTTON

Provider Business Mailing Address
First Line	:	1055 E STEWART AVE BLDG 2018
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80914-2900
Country	:	US
Telephone Number	:	207-841-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 E STEWART AVE BLDG 2018
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80914-2900
Country	:	US
Telephone Number	:	207-841-9936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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Directions to “ BRYLIE BUTTON ” Practice Location

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