MEDICARE: DR. ANDREW ALLSBROOK DMD

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	122300000X	Dentist	T-DEN.00000040	CO

General Provider Information

NPI Number	:	1528684412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW ALLSBROOK DMD

Provider Business Mailing Address
First Line	:	718 MALETA LN
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	757-401-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 MALETA LN
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	303-814-9899
Fax Number	:

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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