MEDICARE: DOUGLAS R DOWDLE, DMD, PC

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

General Provider Information

NPI Number	:	1629366836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS R DOWDLE, DMD, PC

Provider Business Mailing Address
First Line	:	15455 GLENEAGLE DR STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2593
Country	:	US
Telephone Number	:	719-488-2222
Fax Number	:	719-488-4227

Provider Business Practice Location Address
First Line	:	15455 GLENEAGLE DR STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2593
Country	:	US
Telephone Number	:	719-488-2222
Fax Number	:	719-488-4227

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DOUGLAS ROBERT DOWDLE
Credential	:	D.M.D
Telephone Number	:	719-488-2222

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	09/14/2011

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