MEDICARE: DR. TIMOTHY BANDROWSKY 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)	8089	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366448417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY BANDROWSKY D.D.S.

Provider Business Mailing Address
First Line	:	755 S PERRY ST
Second Line	:	STE 300
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1901
Country	:	US
Telephone Number	:	303-660-5651
Fax Number	:	303-660-1582

Provider Business Practice Location Address
First Line	:	755 S PERRY ST
Second Line	:	STE 300
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1901
Country	:	US
Telephone Number	:	303-660-5651
Fax Number	:	303-660-1582

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	05/02/2012

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