Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 7214 | CO |
N | 1223P0700X | Prosthodontist | 7214 | CO |
NPI | 1295740603 |
---|---|
Provider Name | Dr. Brian Todd Pickle |
First Address | Colorado Springs, CO 80920-7979 |
Second Address | Colorado Springs, CO 80920-7979 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |