MEDICARE: DR. JENNIFER UNGER WATERS DDS

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	8005	CO

General Provider Information

NPI Number	:	1588647176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER UNGER WATERS DDS

Provider Business Mailing Address
First Line	:	1600 WASHINGTON AVE
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-1927
Country	:	US
Telephone Number	:	303-279-6621
Fax Number	:	303-216-0278

Provider Business Practice Location Address
First Line	:	1607 WASHINGTON AVE
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-1926
Country	:	US
Telephone Number	:	303-279-6621
Fax Number	:	303-216-0278

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	04/20/2018

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