Organization
BRIDGE STREET DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS WHITELEY DMD (PRESIDENT)
(801) 376-9484
Entity
Organization
Contact information
Practice address
19 N 42ND AVE, BRIGHTON, CO 80601-4351
(720) 583-1425
Mailing address
19 N 42ND AVE, BRIGHTON, CO 80601-4351
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
8920
CO
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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