Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 00010220 | CO |
NPI | 1033346275 |
---|---|
Provider Name | Dr. Brian James Diemer |
First Address | Loveland, CO 80538-1196 |
Second Address | Lakewood, CO 80214-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2009 |
Last Update Date | 28/01/2020 |