MEDICARE: RIGBY DENTAL, P.C.

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	DEN2481	CO
2	1223G0001X	General Practice Dentistry	DEN8692	CO

General Provider Information

NPI Number	:	1265892319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIGBY DENTAL, P.C.

Provider Business Mailing Address
First Line	:	2190 ACADEMY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1659
Country	:	US
Telephone Number	:	719-596-3939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 ACADEMY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1659
Country	:	US
Telephone Number	:	719-596-3939
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TED RIGBY
Credential	:	DDS
Telephone Number	:	719-596-3939

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	04/19/2016

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