MEDICARE: PIONEER HILLS DENTAL, PLLC

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	10189	CO

General Provider Information

NPI Number	:	1649677378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER HILLS DENTAL, PLLC

Provider Business Mailing Address
First Line	:	5492 S PARKER RD
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1136
Country	:	US
Telephone Number	:	303-766-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	5492 S PARKER RD
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1136
Country	:	US
Telephone Number	:	303-766-8811
Fax Number	:	303-690-9425

Authorized Official
Title or Position	:	OWNER
Name	:	TERRANCE WOLBAUM
Credential	:
Telephone Number	:	303-766-8811

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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