MEDICARE: DR. BETH L NIELSEN 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	8278	CO

General Provider Information

NPI Number	:	1568584340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH L NIELSEN D.D.S.

Provider Business Mailing Address
First Line	:	16830 NORTHGATE DR
Second Line	:	SUITE 100
City	:	PARKER
State	:	CO
Zip	:	80134-5778
Country	:	US
Telephone Number	:	303-841-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	16830 NORTHGATE DR
Second Line	:	SUITE 100
City	:	PARKER
State	:	CO
Zip	:	80134-5778
Country	:	US
Telephone Number	:	303-841-9009
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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