Provider Demographics
NPI:1538581301
Name:NIELSEN, BRIKLIN (DDS, MS)
Entity type:Individual
Prefix:
First Name:BRIKLIN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 SCARBOROUGH DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7583
Mailing Address - Country:US
Mailing Address - Phone:719-282-6666
Mailing Address - Fax:719-282-6566
Practice Address - Street 1:8580 SCARBOROUGH DR
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7583
Practice Address - Country:US
Practice Address - Phone:719-282-6666
Practice Address - Fax:719-282-6566
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057061-11223P0221X
CO002027571223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47770155Medicaid