MEDICARE: DAVID P. STANGL, JR., DMD, PROFESSIONAL LLC

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	CO9984	CO

General Provider Information

NPI Number	:	1952718553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID P. STANGL, JR., DMD, PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	2880 FOLSOM ST STE 202
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3769
Country	:	US
Telephone Number	:	303-945-2399
Fax Number	:	303-945-2571

Provider Business Practice Location Address
First Line	:	2880 FOLSOM ST STE 202
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3769
Country	:	US
Telephone Number	:	303-945-2399
Fax Number	:	303-945-2571

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID P STANGL JR.
Credential	:
Telephone Number	:	303-945-2399

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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