Provider Demographics
NPI:1881709913
Name:ORTHODONTIC ASSOCIATES OF GREELEY PC
Entity type:Organization
Organization Name:ORTHODONTIC ASSOCIATES OF GREELEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:NEWHALL
Authorized Official - Last Name:EDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:970-356-5900
Mailing Address - Street 1:3400 W 16TH ST
Mailing Address - Street 2:BLDG 4-V
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6862
Mailing Address - Country:US
Mailing Address - Phone:970-356-5900
Mailing Address - Fax:970-356-2418
Practice Address - Street 1:3400 W 16TH ST
Practice Address - Street 2:BLDG 4-V
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6862
Practice Address - Country:US
Practice Address - Phone:970-356-5900
Practice Address - Fax:970-356-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty