Brian L Secrist DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

105294 Issued in CO

Legal business name

BRIAN L SECRIST DDS PC

Practice address

11401 Washington St
Northglenn, CO 80233-1912

Phone

(303) 254-4444

Fax

(303) 254-6552

NPI assigned

Apr 17, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brian L Secrist, DDS

Title

Dentist/Owner

Phone

(303) 254-4444

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1720475635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11401 WASHINGTON ST",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802331912",
            "telephone_number": "303-254-4444",
            "fax_number": "303-254-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 WASHINGTON ST",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802331912",
            "telephone_number": "303-254-4444",
            "fax_number": "303-254-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN L SECRIST DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "SECRIST",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "303-254-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "105294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.