MEDICARE: CASTLE ROCK COSMETIC AND FAMILY DENTISTRY

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	9200	CO

General Provider Information

NPI Number	:	1528367513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE ROCK COSMETIC AND FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	4625 TRAIL BOSS DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2803
Country	:	US
Telephone Number	:	720-733-1210
Fax Number	:	720-733-1214

Provider Business Practice Location Address
First Line	:	4625 TRAIL BOSS DR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2803
Country	:	US
Telephone Number	:	720-733-1210
Fax Number	:	720-733-1214

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT BARES
Credential	:	D.D.S
Telephone Number	:	720-733-1210

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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Directions to “CASTLE ROCK COSMETIC AND FAMILY DENTISTRY ” Practice Location

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