Provider Demographics
NPI:1558051045
Name:B & G ORTHODONTICS
Entity Type:Organization
Organization Name:B & G ORTHODONTICS
Other - Org Name:COMFORT DENTAL BRACES LONGMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:720-833-5550
Mailing Address - Street 1:700 KEN PRATT BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6455
Mailing Address - Country:US
Mailing Address - Phone:720-833-5550
Mailing Address - Fax:
Practice Address - Street 1:700 KEN PRATT BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6455
Practice Address - Country:US
Practice Address - Phone:720-833-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty