Provider Demographics
NPI:1376193557
Name:BRICE, GLEN (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:BRICE
Suffix:
Gender:M
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 E JEWELL AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5601
Mailing Address - Country:US
Mailing Address - Phone:720-800-3284
Mailing Address - Fax:
Practice Address - Street 1:14044 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3693
Practice Address - Country:US
Practice Address - Phone:720-216-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management