MEDICARE: TANYA KARNAVY 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	1223P0221X	Pediatric Dentistry	2355	HI
2	1223P0221X	Pediatric Dentistry	60388	CA
3	1223P0221X	Pediatric Dentistry	10611	CO

General Provider Information

NPI Number	:	1508134040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA KARNAVY D.D.S.

Provider Business Mailing Address
First Line	:	1818 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3253
Country	:	US
Telephone Number	:	303-651-3733
Fax Number	:	303-485-5380

Provider Business Practice Location Address
First Line	:	1818 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3253
Country	:	US
Telephone Number	:	303-651-3733
Fax Number	:	303-485-5380

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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