MEDICARE: SPRINGS SMILE CENTER

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	261QD0000X	Dental Clinic/Center	2403	CO

General Provider Information

NPI Number	:	1326417197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGS SMILE CENTER

Provider Business Mailing Address
First Line	:	7770 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4087
Country	:	US
Telephone Number	:	719-594-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	7770 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4087
Country	:	US
Telephone Number	:	719-594-9797
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ANTHONY J GEORGE
Credential	:
Telephone Number	:	719-424-8372

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	09/22/2015

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Directions to “SPRINGS SMILE CENTER ” Practice Location

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