Provider Demographics
NPI:1740763119
Name:BRIAN C. LEYPOLDT, DDS, MSD, PLLC
Entity Type:Organization
Organization Name:BRIAN C. LEYPOLDT, DDS, MSD, PLLC
Other - Org Name:LAFAYETTE FAMILY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:LEYPOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:720-699-8855
Mailing Address - Street 1:2377 CEDARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1281
Mailing Address - Country:US
Mailing Address - Phone:720-600-8315
Mailing Address - Fax:
Practice Address - Street 1:110 OLD LARAMIE TRL # 105
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7010
Practice Address - Country:US
Practice Address - Phone:720-699-8855
Practice Address - Fax:720-699-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6026371Medicaid