Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 10541 | CO |
Y | 1223X0400X | Orthodontists | 10541 | CO |
NPI | 1043649361 |
---|---|
Provider Name | Dr. Brian Trommeter |
First Address | Denver, CO 80238-3185 |
Second Address | Denver, CO 80238-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2013 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1760801724 | (05) | CO |