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Organization
CRANIOFACIAL PAIN & SLEEP CENTER, PLLC
Active
Organization
CRANIOFACIAL PAIN & SLEEP CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KINGDON BRADY D.D.S. (OWNER)
(970) 484-0250
Entity
Organization
Contact information
Practice address
2627 REDWING RD, SUITE 300, FORT COLLINS, CO 80526-6321
(970) 484-0250
(970) 484-1522
Mailing address
2627 REDWING RD, SUITE 300, FORT COLLINS, CO 80526-6321
(970) 484-0250
(970) 484-1522
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
202172
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7509330001
MEDICARE PTAN
CO
Enumeration date
01/04/2016
Last updated
06/10/2016
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