MEDICARE: DR. DAVID PAUL MJOS DOS

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	104477	CO

General Provider Information

NPI Number	:	1255331369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL MJOS DOS

Provider Business Mailing Address
First Line	:	1710 BRIARGATE BLVD
Second Line	:	#847
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3449
Country	:	US
Telephone Number	:	719-531-0636
Fax Number	:	719-531-7640

Provider Business Practice Location Address
First Line	:	1710 BRIARGATE BLVD
Second Line	:	#847
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3449
Country	:	US
Telephone Number	:	719-531-0636
Fax Number	:	719-531-7640

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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