=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417327784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIG SKY DENTISTRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2015
-----------------------------------------------------
Last Update Date | 11/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 S TELLER ST SUITE 280
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-7388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-989-4444
-----------------------------------------------------
Fax | 720-583-7490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 S TELLER ST SUITE 280
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-7388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-989-4444
-----------------------------------------------------
Fax | 720-583-7490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. DANIELLE SCHWARTZENBERGER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 303-989-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 9627
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 10138
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------