MEDICARE: ACACIA DENTAL GROUP, P.C.

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		CO

General Provider Information

NPI Number	:	1588848568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACACIA DENTAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	3624 S. PENNSYLVANIA ST.
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113
Country	:	US
Telephone Number	:	303-781-0624
Fax Number	:	303-781-9551

Provider Business Practice Location Address
First Line	:	3627 S PENNSYLVANIA ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3753
Country	:	US
Telephone Number	:	303-781-0624
Fax Number	:	303-781-9551

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BARBARA J LOTZE
Credential	:
Telephone Number	:	303-781-0624

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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