MEDICARE: GEORGE V. RANTA, D.D. S., A PROFESSIONAL CORPORATION

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	270	CO

General Provider Information

NPI Number	:	1033246368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE V. RANTA, D.D. S., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	6980 MESA RIDGE PKWY
Second Line	:	SUITE 200
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1563
Country	:	US
Telephone Number	:	719-392-4231
Fax Number	:	719-392-9096

Provider Business Practice Location Address
First Line	:	6980 MESA RIDGE PKWY
Second Line	:	SUITE 200
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1563
Country	:	US
Telephone Number	:	719-392-4231
Fax Number	:	719-392-9096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE V. RANTA
Credential	:	DDS
Telephone Number	:	719-392-4231

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	06/30/2008

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