Provider Demographics
NPI:1174014963
Name:O AND A DENTAL AND BRACES AT BRIGHTON PLLC
Entity Type:Organization
Organization Name:O AND A DENTAL AND BRACES AT BRIGHTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-659-1064
Mailing Address - Street 1:1790 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-1934
Mailing Address - Country:US
Mailing Address - Phone:303-659-1064
Mailing Address - Fax:303-659-1065
Practice Address - Street 1:1790 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1934
Practice Address - Country:US
Practice Address - Phone:303-659-1064
Practice Address - Fax:303-659-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty