Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DEN.00202446 | CO |
NPI | 1003233701 |
---|---|
Provider Name | Nicholas Brown |
First Address | Breckenridge, CO 80424-1817 |
Second Address | Breckenridge, CO 80424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2014 |
Last Update Date | 08/07/2015 |