Provider Demographics
NPI:1205877966
Name:BRADA, BRIAN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:BRADA
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 1:255 UNION BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1810
Mailing Address - Country:US
Mailing Address - Phone:303-279-3439
Mailing Address - Fax:
Practice Address - Street 1:255 UNION BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1810
Practice Address - Country:US
Practice Address - Phone:303-914-8337
Practice Address - Fax:303-914-8323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046621223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO453598Medicare ID - Type UnspecifiedMEDICARE # FOR OFFICE
CO453688Medicare ID - Type Unspecified
COU37548Medicare UPIN