MEDICARE: DAVID ALLEN HEDRICK 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	122300000X	Dentist	HD 104321	CO

General Provider Information

NPI Number	:	1922137066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN HEDRICK D.D.S.

Provider Business Mailing Address
First Line	:	5490 S WACO ST
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-2654
Country	:	US
Telephone Number	:	303-693-1851
Fax Number	:

Provider Business Practice Location Address
First Line	:	12357 E CORNELL AVE
Second Line	:	#10
City	:	AURORA
State	:	CO
Zip	:	80014-3323
Country	:	US
Telephone Number	:	303-337-5800
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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