MEDICARE: DR. ROBERT CHARLES ELLIOTT D.D.S.10

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	7188	CO

General Provider Information

NPI Number	:	1093860769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES ELLIOTT D.D.S.10

Provider Business Mailing Address
First Line	:	101 SUNDIAL DR STE A
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-7769
Country	:	US
Telephone Number	:	719-686-1800
Fax Number	:	719-686-1818

Provider Business Practice Location Address
First Line	:	101 SUNDIAL DR STE A
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-7769
Country	:	US
Telephone Number	:	719-686-1800
Fax Number	:	719-686-1818

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	01/29/2015

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