Provider Demographics
NPI:1992009815
Name:HOULBERG, BRYAN J (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:J
Last Name:HOULBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15403 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2403
Mailing Address - Country:US
Mailing Address - Phone:303-680-3295
Mailing Address - Fax:303-680-4438
Practice Address - Street 1:15403 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2403
Practice Address - Country:US
Practice Address - Phone:303-680-3295
Practice Address - Fax:303-680-4438
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics