Provider Demographics
NPI:1821711086
Name:BRIANNA NICHOLSON
Entity Type:Organization
Organization Name:BRIANNA NICHOLSON
Other - Org Name:B. NICHOLSON DDS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-278-3157
Mailing Address - Street 1:7373 W JEFFERSON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2020
Mailing Address - Country:US
Mailing Address - Phone:303-217-5221
Mailing Address - Fax:
Practice Address - Street 1:7373 W JEFFERSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2020
Practice Address - Country:US
Practice Address - Phone:303-217-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31574521Medicaid