MEDICARE: PETER FREDERICK STEINHAUER 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3202	CO

General Provider Information

NPI Number	:	1306113261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER FREDERICK STEINHAUER D.D.S.

Provider Business Mailing Address
First Line	:	7492 SPRING DR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-5120
Country	:	US
Telephone Number	:	303-499-1278
Fax Number	:	303-543-2351

Provider Business Practice Location Address
First Line	:	7492 SPRING DR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-5120
Country	:	US
Telephone Number	:	303-499-1278
Fax Number	:	303-543-2351

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

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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