MEDICARE: DR. SCOTT WAYNE HIRSBRUNNER DMD

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	D009859	AZ
2	122300000X	Dentist	00203761	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154848455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT WAYNE HIRSBRUNNER DMD

Provider Business Mailing Address
First Line	:	3952 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5923
Country	:	US
Telephone Number	:	719-591-1811
Fax Number	:	719-591-2032

Provider Business Practice Location Address
First Line	:	3952 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5923
Country	:	US
Telephone Number	:	719-591-1811
Fax Number	:	719-591-2032

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

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	08/01/2019

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