NPIMap

Individual provider Active NPI

Brendan Withycombe, DMD

  • General Practice Dentistry
  • Frisco, CO
National Provider Identifier
1861170110
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DEN.00205722 Issued in CO
Practice address
360 Peak One Dr Ste 325
Frisco, CO 80443-5948
Phone
(970) 668-4055
NPI assigned
Jul 7, 2023
Last updated
Jul 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DEN.00205722 CO Primary

Addresses

Primary practice location

360 Peak One Dr Ste 325
Frisco, CO 80443-5948

Mailing address

1612 Mount Evans Dr
Leadville, CO 80461-3720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DEN.00205722COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Community Care Clinic, Inc. PastSince Jun 4, 2023 Accepting new patients
Summit Community Care Clinic, Inc. Past Accepting new patients
Summit Community Care Clinic, Inc. Past Accepting new patients
Summit Community Care Clinic, Inc. PastSince Aug 11, 2019 Accepting new patients
Summit Community Care Clinic, Inc. Past Accepting new patients
Summit Community Care Clinic, Inc. Past Accepting new patients
Summit Community Care Clinic, Inc. Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1861170110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 MOUNT EVANS DR",
            "city": "LEADVILLE",
            "state": "CO",
            "postal_code": "804613720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 PEAK ONE DR STE 325",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804435948",
            "telephone_number": "970-668-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITHYCOMBE",
        "first_name": "BRENDAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00205722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.