MEDICARE: DR. PHILIP J LATTEIER 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	122300000X	Dentist	0401411334	VA
2	1223G0001X	General Practice Dentistry	9631	CO

General Provider Information

NPI Number	:	1073622163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP J LATTEIER D.D.S.

Provider Business Mailing Address
First Line	:	2532 PATTERSON RD
Second Line	:	SUITE 1
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-3604
Country	:	US
Telephone Number	:	970-243-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 PATTERSON RD
Second Line	:	SUITE 1
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-3604
Country	:	US
Telephone Number	:	970-243-9292
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/26/2013

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