Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DEN-9157 | CO |
NPI | 1104850379 |
---|---|
Provider Name | Dr. Brad W Eckhardt |
First Address | Fort Collins, CO 80524-2031 |
Second Address | Fort Collins, CO 80524-2031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |