Provider Demographics
NPI:1396057816
Name:MCBRIDE FAMILY DENTISTRY
Entity type:Organization
Organization Name:MCBRIDE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-917-8961
Mailing Address - Street 1:925 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1973
Mailing Address - Country:US
Mailing Address - Phone:303-466-2221
Mailing Address - Fax:303-466-7735
Practice Address - Street 1:925 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1973
Practice Address - Country:US
Practice Address - Phone:303-466-2221
Practice Address - Fax:303-466-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-102331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty