MEDICARE: DR. DOUGLAS ROBERT DOWDLE 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	D4160	ID
2	1223G0001X	General Practice Dentistry	10536	CO

General Provider Information

NPI Number	:	1083876775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ROBERT DOWDLE DMD

Provider Business Mailing Address
First Line	:	15455 GLENEAGLE DR STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2593
Country	:	US
Telephone Number	:	719-488-2222
Fax Number	:	719-488-4227

Provider Business Practice Location Address
First Line	:	15455 GLENEAGLE DR STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2593
Country	:	US
Telephone Number	:	719-488-2222
Fax Number	:	719-488-4227

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	09/14/2011

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