MEDICARE: ALL-STAR DENTAL CARE, PC

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	9295	CO

General Provider Information

NPI Number	:	1952788382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL-STAR DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	830 TENDERFOOT HILL RD
Second Line	:	SUITE 210
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-2314
Country	:	US
Telephone Number	:	719-440-7781
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 TENDERFOOT HILL RD
Second Line	:	SUITE 210
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-2314
Country	:	US
Telephone Number	:	719-440-7781
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. OLIVER M SPAETH
Credential	:	DDS
Telephone Number	:	719-440-7781

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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