Provider Demographics
NPI:1902006489
Name:GORDON, BRYNNE COLES ANDERSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYNNE
Middle Name:COLES ANDERSON
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 23RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4384
Mailing Address - Country:US
Mailing Address - Phone:970-945-8753
Mailing Address - Fax:970-945-4970
Practice Address - Street 1:401 23RD ST STE 202
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4384
Practice Address - Country:US
Practice Address - Phone:970-945-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9412122300000X
IL019027584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist