Provider Demographics
NPI:1679147565
Name:BRIDGECREEK PROSTHETIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:BRIDGECREEK PROSTHETIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PARTNER-DENTISTPROSTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:COIT
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-755-4003
Mailing Address - Street 1:8751 E. HAMPDEN AVENUE
Mailing Address - Street 2:SUITE C6
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4930
Mailing Address - Country:US
Mailing Address - Phone:303-755-4003
Mailing Address - Fax:303-743-9638
Practice Address - Street 1:8751 E. HAMPDEN AVENUE
Practice Address - Street 2:SUITE C6
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4930
Practice Address - Country:US
Practice Address - Phone:303-755-4003
Practice Address - Fax:303-743-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty