Basic Information
| Provider Information | |||||||||
| NPI: | 1881843936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAULUS | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | COLLINS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S., M.S.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7560 RANGEWOOD DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809204199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195963113 | ||||||||
| FaxNumber: | 7195963254 | ||||||||
| Practice Location | |||||||||
| Address1: | 7560 RANGEWOOD DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809204199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195963113 | ||||||||
| FaxNumber: | 7195963254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2008 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 10167 | CO | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.