MEDICARE: CABLE DENTAL INC

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	122300000X	Dentist	8610	CO

General Provider Information

NPI Number	:	1821208968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABLE DENTAL INC

Provider Business Mailing Address
First Line	:	3850 STUART ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 SHERIDAN BLVD
Second Line	:	SUITE 1
City	:	DENVER
State	:	CO
Zip	:	80214-3011
Country	:	US
Telephone Number	:	303-477-7700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RYAN CABLE
Credential	:
Telephone Number	:	303-477-7700

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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