MEDICARE: DR. PETER BRENT AMUNDSON D.M.D.

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	007485	CO

General Provider Information

NPI Number	:	1073690889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER BRENT AMUNDSON D.M.D.

Provider Business Mailing Address
First Line	:	7960 S UNIVERSITY BLVD
Second Line	:	STE 200
City	:	CENTENNIAL
State	:	CO
Zip	:	80122
Country	:	US
Telephone Number	:	303-773-9400
Fax Number	:	303-773-9518

Provider Business Practice Location Address
First Line	:	7900 S UNIVERSITY BLVD
Second Line	:	SUITE 100
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-5102
Country	:	US
Telephone Number	:	303-773-9400
Fax Number	:	303-773-9518

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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