Provider Demographics
NPI:1154692051
Name:BRANDON D VISSCHER DMD PLLC
Entity type:Organization
Organization Name:BRANDON D VISSCHER DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRISPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-279-6929
Mailing Address - Street 1:1726 COLE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3213
Mailing Address - Country:US
Mailing Address - Phone:303-279-6929
Mailing Address - Fax:303-279-8907
Practice Address - Street 1:1726 COLE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3213
Practice Address - Country:US
Practice Address - Phone:303-279-6929
Practice Address - Fax:303-279-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty