MEDICARE: EMERGENCY DENTAL CARE USA, LLP.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1407979453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY DENTAL CARE USA, LLP.

Provider Business Mailing Address
First Line	:	6531 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8342
Country	:	US
Telephone Number	:	719-302-3143
Fax Number	:

Provider Business Practice Location Address
First Line	:	6531 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8342
Country	:	US
Telephone Number	:	719-302-3143
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	TODD GIBLETTE
Credential	:
Telephone Number	:	719-302-3143

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/22/2020

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