MEDICARE: HOMECARE DENTAL SERVICE, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063492155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMECARE DENTAL SERVICE, INC.

Provider Business Mailing Address
First Line	:	7100 BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-2917
Country	:	US
Telephone Number	:	303-650-5800
Fax Number	:	303-650-5801

Provider Business Practice Location Address
First Line	:	7100 BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-2915
Country	:	US
Telephone Number	:	303-650-5800
Fax Number	:	303-650-5801

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JANET LEE
Credential	:
Telephone Number	:	303-650-5800

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/31/2008

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