Provider Demographics
NPI:1164918611
Name:ENDODONTICS OF THE ROCKIES, LLC
Entity Type:Organization
Organization Name:ENDODONTICS OF THE ROCKIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:970-568-5255
Mailing Address - Street 1:1903 WILMINGTON DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6100
Mailing Address - Country:US
Mailing Address - Phone:970-568-5255
Mailing Address - Fax:970-568-5256
Practice Address - Street 1:1903 WILMINGTON DR UNIT 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6100
Practice Address - Country:US
Practice Address - Phone:970-568-5255
Practice Address - Fax:970-568-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002035111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty