MEDICARE: DR. MARC ANDREW ALBER D.D.S.

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	7866	CO

General Provider Information

NPI Number	:	1063598746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ANDREW ALBER D.D.S.

Provider Business Mailing Address
First Line	:	2919 VALMONT RD
Second Line	:	SUITE 106
City	:	BOULDER
State	:	CO
Zip	:	80301-1350
Country	:	US
Telephone Number	:	303-449-3132
Fax Number	:	303-449-4320

Provider Business Practice Location Address
First Line	:	2919 VALMONT RD
Second Line	:	SUITE 106
City	:	BOULDER
State	:	CO
Zip	:	80301-1350
Country	:	US
Telephone Number	:	303-449-3132
Fax Number	:	303-449-4320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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