Provider Demographics
NPI:1073631479
Name:BERTAGNOLLI, JOSEPH D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:BERTAGNOLLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 BRADBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5224
Mailing Address - Country:US
Mailing Address - Phone:303-429-6222
Mailing Address - Fax:303-429-7247
Practice Address - Street 1:7100 BROADWAY
Practice Address - Street 2:SUITE 1P
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2915
Practice Address - Country:US
Practice Address - Phone:303-650-5800
Practice Address - Fax:303-650-5801
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist