MEDICARE: LORETTA MICHELLE DUVERNEY 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
1	1223G0001X	General Practice Dentistry	DEN1000555	DC

General Provider Information

NPI Number	:	1740416700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA MICHELLE DUVERNEY DDS

Provider Business Mailing Address
First Line	:	3401 GEORGIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2501
Country	:	US
Telephone Number	:	202-829-5437
Fax Number	:	202-829-9255

Provider Business Practice Location Address
First Line	:	201 W 8TH ST
Second Line	:	SUITE 810
City	:	PUEBLO
State	:	CO
Zip	:	81003-3038
Country	:	US
Telephone Number	:	719-562-4468
Fax Number	:	719-583-1801

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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