Provider Demographics
NPI:1033346275
Name:DIEMER, BRIAN JAMES (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:DIEMER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-1196
Mailing Address - Country:US
Mailing Address - Phone:970-203-1821
Mailing Address - Fax:
Practice Address - Street 1:7355 W COLFAX AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5407
Practice Address - Country:US
Practice Address - Phone:303-202-0880
Practice Address - Fax:303-202-0882
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000102201223X0400X
IL021.0022021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics