MEDICARE: DR. KEN GASPER II D.D.S.

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	5116	CO

General Provider Information

NPI Number	:	1619916160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN GASPER II D.D.S.

Provider Business Mailing Address
First Line	:	8610 EXPLORER DR
Second Line	:	STE. 315
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1058
Country	:	US
Telephone Number	:	719-599-0700
Fax Number	:	719-599-8745

Provider Business Practice Location Address
First Line	:	8610 EXPLORER DR
Second Line	:	STE. 315
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1058
Country	:	US
Telephone Number	:	719-599-0700
Fax Number	:	719-599-8745

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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