MEDICARE: EMBRACEABLE LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	00280	CO
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8637	CO
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	105444	CO

General Provider Information

NPI Number	:	1538296892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACEABLE LLC

Provider Business Mailing Address
First Line	:	13980 W EXPOSITION PL
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2344
Country	:	US
Telephone Number	:	303-985-3686
Fax Number	:	303-985-3011

Provider Business Practice Location Address
First Line	:	1512 GRAND AVE
Second Line	:	SUITE 102
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3861
Country	:	US
Telephone Number	:	970-945-2588
Fax Number	:	970-928-0741

Authorized Official
Title or Position	:	PARTNER OWNER
Name	:	DR. CLAUDE MICHAEL BLOSS
Credential	:	D.D.S.
Telephone Number	:	303-985-3686

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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