Provider Demographics
NPI:1275093890
Name:POORE, BRIAN RICHARD
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:POORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RAMPART WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6443
Mailing Address - Country:US
Mailing Address - Phone:303-341-7151
Mailing Address - Fax:
Practice Address - Street 1:4700 E BROMLEY LN STE 105
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-7821
Practice Address - Country:US
Practice Address - Phone:303-341-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002049991223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery