MEDICARE: DR. BETH ANN DORIAN DMD

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	10088	CO
2	122300000X	Dentist	DN012540	GA
3	1223G0001X	General Practice Dentistry	DN012540	GA
4	1223G0001X	General Practice Dentistry	10088	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	:	1891830246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH ANN DORIAN DMD

Provider Business Mailing Address
First Line	:	340 JUSTIN AVE
Second Line	:	SUITE 102
City	:	PLATTEVILLE
State	:	CO
Zip	:	80651-7818
Country	:	US
Telephone Number	:	970-353-2330
Fax Number	:	970-797-6403

Provider Business Practice Location Address
First Line	:	340 JUSTIN AVE
Second Line	:	SUITE 102
City	:	PLATTEVILLE
State	:	CO
Zip	:	80651-7818
Country	:	US
Telephone Number	:	970-785-6280
Fax Number	:	970-797-6403

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	02/03/2015

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