MEDICARE: DR. GARY LEE BLUMENSCHEIN 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	1223G0001X	General Practice Dentistry	3790	CO

General Provider Information

NPI Number	:	1437276235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LEE BLUMENSCHEIN D.D.S.

Provider Business Mailing Address
First Line	:	8424 WEST 25TH STREET
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1763
Country	:	US
Telephone Number	:	303-233-7487
Fax Number	:	303-233-7487

Provider Business Practice Location Address
First Line	:	8424 WEST 25TH STREET
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1763
Country	:	US
Telephone Number	:	303-233-7487
Fax Number	:	303-233-7487

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

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	01/16/2008

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