MEDICARE: CASTLE ROCK ORTHODONTICS PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7797	CO

General Provider Information

NPI Number	:	1184883704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE ROCK ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	718 MALETA LN
Second Line	:	SUITE 201
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	303-688-8777
Fax Number	:	303-688-6699

Provider Business Practice Location Address
First Line	:	718 MALETA LN
Second Line	:	SUITE 201
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	303-688-8777
Fax Number	:	303-688-6699

Authorized Official
Title or Position	:	OWNER ORTHODONTIST
Name	:	DR. ANDREW JOSEPH DUNBAR
Credential	:	DDS MS
Telephone Number	:	303-688-8777

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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