MEDICARE: DR. NICHOLAS ANTHONY POLITANO 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	1223G0001X	General Practice Dentistry	8631	CO
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8631	CO

General Provider Information

NPI Number	:	1811961394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ANTHONY POLITANO D.D.S.

Provider Business Mailing Address
First Line	:	8025 CLUB CREST DR
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80005-2269
Country	:	US
Telephone Number	:	303-431-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 CLUB CREST DR
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80005-2269
Country	:	US
Telephone Number	:	303-431-0033
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/20/2011

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