Organization
BRACES4KIDS, PLLC
Active
Organization
BRACES4KIDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER H JOLLEY DMD (DOCTOR/OWNER)
(970) 523-6333
Entity
Organization
Contact information
Practice address
2400 W 16TH ST, GREELEY, CO 80634-6067
(970) 523-6333
(970) 243-3008
Mailing address
601 28 1/4 RD UNIT E, GRAND JUNCTION, CO 81506-6022
(970) 523-6333
(970) 243-3008
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
10718
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
9143
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154675874
—
CO
05
—
1588763528
—
CO
Enumeration date
06/05/2015
Last updated
06/05/2015
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