MEDICARE: PATRICIA CHRISTMON

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	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1366979601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CHRISTMON

Provider Business Mailing Address
First Line	:	4340 LOOMIS AVE APT A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-5214
Country	:	US
Telephone Number	:	719-201-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	4340 LOOMIS AVE APT A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-5214
Country	:	US
Telephone Number	:	719-201-3521
Fax Number	:

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

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	07/21/2022

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Directions to “ PATRICIA CHRISTMON ” Practice Location

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