Provider Demographics
NPI:1306844667
Name:SECRIST, BRIAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:SECRIST
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 1:7418 S QUAIL CIR
Mailing Address - Street 2:#1321
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5896
Mailing Address - Country:US
Mailing Address - Phone:303-859-6016
Mailing Address - Fax:
Practice Address - Street 1:7418 S QUAIL CIR
Practice Address - Street 2:#1321
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5896
Practice Address - Country:US
Practice Address - Phone:303-859-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1052941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice