1154692051 NPI number — BRANDON D VISSCHER DMD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154692051 NPI number — BRANDON D VISSCHER DMD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANDON D VISSCHER DMD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154692051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1726 COLE BLVD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-279-6929
Provider Business Mailing Address Fax Number:
303-279-8907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1726 COLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-279-6929
Provider Business Practice Location Address Fax Number:
303-279-8907
Provider Enumeration Date:
01/24/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRISPE
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
303-279-6929

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)