MEDICARE: DR. JONATHAN PETER BAYNE 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	9338	CO

General Provider Information

NPI Number	:	1164409363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN PETER BAYNE D.D.S

Provider Business Mailing Address
First Line	:	1045 E STEWART AVE BLDG 2012T
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80914-2900
Country	:	US
Telephone Number	:	719-556-1333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 E STEWART AVE BLDG 2012T
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80914-2900
Country	:	US
Telephone Number	:	719-556-1333
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	05/16/2023

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