MEDICARE: ALPHA DENTAL CARE V PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	1223G0001X	General Practice Dentistry	CO
2	1223P0300X	Periodontics	CO
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	CO
4	1223E0200X	Endodontics	CO

General Provider Information

NPI Number	:	1992195267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA DENTAL CARE V PC

Provider Business Mailing Address
First Line	:	9400 STATION ST
Second Line	:	SUITE 175
City	:	LONE TREE
State	:	CO
Zip	:	80124-6808
Country	:	US
Telephone Number	:	303-779-2797
Fax Number	:	303-779-2687

Provider Business Practice Location Address
First Line	:	9400 STATION ST
Second Line	:	STE 175
City	:	LONE TREE
State	:	CO
Zip	:	80124-6808
Country	:	US
Telephone Number	:	303-779-2797
Fax Number	:	303-779-2687

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARY BLAKELEY
Credential	:	DDS
Telephone Number	:	303-779-2797

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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Directions to “ALPHA DENTAL CARE V PC ” Practice Location

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