Organization
NORTHERN COLORADO ENDODONTICS
Active
Parent organization
NORTHERN COLORADO ENDODONTICS
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHERN COLORADO ENDODONTICS
Authorized official
BRADLEY LEVALLEY D.D.S., M.S. (PRESIDENT)
(970) 229-1404
Entity
Organization
Contact information
Practice address
630 15TH AVE, SUITE 301, LONGMONT, CO 80501-2700
(720) 494-9363
(720) 494-9364
Mailing address
630 15TH AVE, SUITE 301, LONGMONT, CO 80501-2700
(720) 494-9363
(720) 494-9364
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7382
CO
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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