1447640636 NPI number — R. BRADLEY BERRYHILL, DMD PC

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 1447640636 NPI number — R. BRADLEY BERRYHILL, DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. BRADLEY BERRYHILL, DMD PC
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:
1447640636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 YOUNGFIELD ST
Provider Second Line Business Mailing Address:
STE 211
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-2263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-233-1354
Provider Business Mailing Address Fax Number:
303-233-1412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 YOUNGFIELD ST
Provider Second Line Business Practice Location Address:
STE 211
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-233-1354
Provider Business Practice Location Address Fax Number:
303-233-1412
Provider Enumeration Date:
01/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BERRYHILL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-233-1354

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10019 , 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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