Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7957 | CO |
NPI | 1003925058 |
---|---|
Provider Name | Mr. Brandon Dean Schultz |
First Address | Centennial, CO 80016 |
Second Address | Centennial, CO 80016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |