Provider Demographics
NPI:1003952516
Name:FRUTCHEY, BRIAN
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:FRUTCHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W SOUTH BOULDER RD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2417
Mailing Address - Country:US
Mailing Address - Phone:303-665-6120
Mailing Address - Fax:
Practice Address - Street 1:850 W SOUTH BOULDER RD UNIT 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2417
Practice Address - Country:US
Practice Address - Phone:303-665-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics