MEDICARE: DR. JOSEPH D BERTAGNOLLI DDS

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	9156	CO

General Provider Information

NPI Number	:	1073631479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH D BERTAGNOLLI DDS

Provider Business Mailing Address
First Line	:	7280 BRADBURN BLVD
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80030-5224
Country	:	US
Telephone Number	:	303-429-6222
Fax Number	:	303-429-7247

Provider Business Practice Location Address
First Line	:	7100 BROADWAY
Second Line	:	SUITE 1P
City	:	DENVER
State	:	CO
Zip	:	80221-2915
Country	:	US
Telephone Number	:	303-650-5800
Fax Number	:	303-650-5801

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	10/21/2014

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