MEDICARE: DR. HOWARD B SHORT 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	122300000X	Dentist	106012	CO

General Provider Information

NPI Number	:	1487754982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD B SHORT DMD

Provider Business Mailing Address
First Line	:	5739 CONSTITUTION AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1220
Country	:	US
Telephone Number	:	719-574-7631
Fax Number	:	719-574-1290

Provider Business Practice Location Address
First Line	:	5739 CONSTITUTION AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1220
Country	:	US
Telephone Number	:	719-574-7631
Fax Number	:	719-574-1290

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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