MEDICARE: BE-CO-ME 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	DEN9157	CO

General Provider Information

NPI Number	:	1003111618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE-CO-ME LLC

Provider Business Mailing Address
First Line	:	PO BOX 1038
Second Line	:
City	:	AULT
State	:	CO
Zip	:	80610-1038
Country	:	US
Telephone Number	:	970-834-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 NORTH 2ND AVENUE
Second Line	:
City	:	AULT
State	:	CO
Zip	:	80610
Country	:	US
Telephone Number	:	970-834-2058
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRADLEY WILLIAM ECKHARDT
Credential	:	DDS
Telephone Number	:	970-834-2058

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	01/13/2011

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Directions to “BE-CO-ME LLC ” Practice Location

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