1720753353 NPI number — DR. NAGAPOORNIMA RACHEL BROWN DDS

Table of content: DR. NAGAPOORNIMA RACHEL BROWN DDS (NPI 1720753353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720753353 NPI number — DR. NAGAPOORNIMA RACHEL BROWN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
NAGAPOORNIMA
Provider Middle Name:
RACHEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PADMANABHAN
Provider Other First Name:
NAGAPOORNIMA
Provider Other Middle Name:
RACHEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720753353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8240 COUNTY ROAD 115 UNIT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81601-9089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-481-8157
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
371 ROBINSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASALT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81621-8399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-927-9112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DEN.00204870 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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