Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 104662 | CO |
NPI | 1205877966 |
---|---|
Provider Name | Dr. Brian John Brada |
First Address | Lakewood, CO 80228-1810 |
Second Address | Lakewood, CO 80228-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U37548 | (02) | CO |