Organization
GOVERNOR'S PARK DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY L BREWICK D.D.S. (OWNER)
(303) 832-7789
Entity
Organization
Contact information
Practice address
700 E 9TH AVE, SUITE 102, DENVER, CO 80203-3360
(303) 832-7789
(303) 832-0427
Mailing address
700 E 9TH AVE, SUITE 102, DENVER, CO 80203-3360
(303) 832-7789
(303) 832-0427
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
105046
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105046
COLORADO DENTAL LISC #
CO
Enumeration date
07/15/2006
Last updated
10/17/2007
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