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NPI Code Detail

MEDICARE: DR. CHAD EVAN FRUITHANDLER DDS

MEDICARE:  DR. CHAD EVAN FRUITHANDLER  DDS
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
1122300000XDentist00203185CO

General Provider Information

NPI Number : 1609306349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD EVAN FRUITHANDLER DDS
Provider Business Mailing Address
First Line : 1250 CHEROKEE ST APT 520
Second Line :
City : DENVER
State : CO
Zip : 80204-3701
Country : US
Telephone Number : 915-731-6950
Fax Number :
Provider Business Practice Location Address
First Line : 1245 E COLFAX AVE STE 301
Second Line :
City : DENVER
State : CO
Zip : 80218-2216
Country : US
Telephone Number : 303-832-8655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2017
Last Update Date : 06/15/2017

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Directions to “ DR. CHAD EVAN FRUITHANDLER DDS” Practice Location

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