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General NPI Number Information
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NPI Number | 1962642256
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Entity Type | Organization
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Legal Business Name | HE DENTTECH, PLLC
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 7750 N UNION BLVD STE.101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4051
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Country | US
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Telephone | 719-598-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 2376 RUSTY RIDGE CT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-2086
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Country | US
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Telephone | 719-487-8961
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. THOMAS RICHARD BAUMGARDNER JR.
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Credential | D.M.D.
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Telephone | 719-487-8961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8566
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License Number State | CO
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