MEDICARE: DR. NELLY BARRETO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8014	CO

General Provider Information

NPI Number	:	1023019841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELLY BARRETO DMD

Provider Business Mailing Address
First Line	:	5929 CONSTITUTION AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1211
Country	:	US
Telephone Number	:	719-638-1986
Fax Number	:	719-638-7532

Provider Business Practice Location Address
First Line	:	5929 CONSTITUTION AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1211
Country	:	US
Telephone Number	:	719-638-1986
Fax Number	:	719-638-7532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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