MEDICARE: DR. DENNIS LEE SIMCIK DDS

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	8621	CO

General Provider Information

NPI Number	:	1497756225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS LEE SIMCIK DDS

Provider Business Mailing Address
First Line	:	149 W HARVARD ST STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2186
Country	:	US
Telephone Number	:	970-223-9790
Fax Number	:	970-223-9791

Provider Business Practice Location Address
First Line	:	149 W HARVARD ST STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2186
Country	:	US
Telephone Number	:	970-223-9790
Fax Number	:	970-223-9791

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/08/2008

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