MEDICARE: NICHOLS & SNAVELY PEDIATRIC DENTISTRY, PLLC

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	9659	CO

General Provider Information

NPI Number	:	1528341435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLS & SNAVELY PEDIATRIC DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	11201 RODEO CIR
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80138-7346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4383 TENNYSON ST UNIT 1-F
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2315
Country	:	US
Telephone Number	:	303-261-7029
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KELSEY DORINE SNAVELY AKIN
Credential	:	DDS
Telephone Number	:	303-261-7029

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/27/2011

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