Provider Demographics
NPI:1568759785
Name:POE, CHRIS BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:BRADLEY
Last Name:POE
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 1:257 SHERMAN ST STE C
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-8723
Mailing Address - Country:US
Mailing Address - Phone:970-512-8722
Mailing Address - Fax:970-672-0253
Practice Address - Street 1:257 SHERMAN ST STE C
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-8723
Practice Address - Country:US
Practice Address - Phone:970-512-8722
Practice Address - Fax:970-672-0253
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104931223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice