MEDICARE: DR. RODGER JAMES DROEL D.D.S., M.S.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3768	CO
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7411	MN

General Provider Information

NPI Number	:	1407968480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODGER JAMES DROEL D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	2290 KIPLING ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1578
Country	:	US
Telephone Number	:	303-232-3737
Fax Number	:	303-232-3753

Provider Business Practice Location Address
First Line	:	2451 15TH ST NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-5592
Country	:	US
Telephone Number	:	651-633-8191
Fax Number	:	651-633-5554

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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