MEDICARE: SPRINGS FAMILY DENTAL, 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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1538531173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGS FAMILY DENTAL, PLLC

Provider Business Mailing Address
First Line	:	1935 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2229
Country	:	US
Telephone Number	:	719-634-4805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2229
Country	:	US
Telephone Number	:	719-634-4805
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL DAVID TERVEEN
Credential	:	DDS
Telephone Number	:	719-634-4805

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	07/29/2024

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