Provider Demographics
NPI:1043679087
Name:BRAY, PAMELA NICHOL (RDH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:NICHOL
Last Name:BRAY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:NICHOL
Other - Last Name:RICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:81423-0280
Mailing Address - Country:US
Mailing Address - Phone:970-327-4233
Mailing Address - Fax:970-327-4228
Practice Address - Street 1:1350 S ASPEN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:CO
Practice Address - Zip Code:81423
Practice Address - Country:US
Practice Address - Phone:970-327-4233
Practice Address - Fax:970-327-4228
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000904428124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist