Individual
DR. KINGDON KIBBLE BRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
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
1223G0001X
General Practice Dentistry
Primary
12010038A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200231810
—
IN
Enumeration date
04/03/2006
Last updated
01/04/2016
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