MEDICARE: CLINICA DENTAL LATINA

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	305R00000X	Preferred Provider Organization	8424	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639323496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA DENTAL LATINA

Provider Business Mailing Address
First Line	:	11175 E MISSISSIPPI AVE
Second Line	:	SUITE 100
City	:	AURORA
State	:	CO
Zip	:	80012-3137
Country	:	US
Telephone Number	:	303-364-9831
Fax Number	:	303-364-7985

Provider Business Practice Location Address
First Line	:	11175 E MISSISSIPPI AVE
Second Line	:	SUITE 100
City	:	AURORA
State	:	CO
Zip	:	80012-3137
Country	:	US
Telephone Number	:	303-364-9831
Fax Number	:	303-364-7985

Authorized Official
Title or Position	:	OWNER
Name	:	GIACOMO GAMIBINI
Credential	:	D.D
Telephone Number	:	303-364-9831

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	03/30/2009

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Directions to “CLINICA DENTAL LATINA ” Practice Location

Language	Start Address	Practice Location

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