MEDICARE: DR. JAMES F DESCHENE 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	1223G0001X	General Practice Dentistry	105573	CO

General Provider Information

NPI Number	:	1548232499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES F DESCHENE D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-0043
Country	:	US
Telephone Number	:	970-532-4209
Fax Number	:	970-532-4175

Provider Business Practice Location Address
First Line	:	430 BIMSON AVE
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-1395
Country	:	US
Telephone Number	:	970-532-4209
Fax Number	:	970-532-4175

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

Provider Enumeration Date	:	02/05/2006
Last Update Date	:	07/08/2007

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