Provider Demographics
NPI:1174044465
Name:RAASCH, BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:RAASCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E 16TH AVE APT 249
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1682
Mailing Address - Country:US
Mailing Address - Phone:970-402-9617
Mailing Address - Fax:
Practice Address - Street 1:101 E BISON HWY
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:CO
Practice Address - Zip Code:80642-5028
Practice Address - Country:US
Practice Address - Phone:720-613-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist