Provider Demographics
NPI:1740573773
Name:NOLAN BROTHERTON DDS PC
Entity Type:Organization
Organization Name:NOLAN BROTHERTON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MULLANE
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-715-8132
Mailing Address - Street 1:5191 W 112TH AVE
Mailing Address - Street 2:UNIT A/B
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2177
Mailing Address - Country:US
Mailing Address - Phone:303-465-5900
Mailing Address - Fax:303-465-5901
Practice Address - Street 1:5191 W 112TH AVE
Practice Address - Street 2:UNIT A/B
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2177
Practice Address - Country:US
Practice Address - Phone:303-465-5900
Practice Address - Fax:303-465-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty