MEDICARE: TRI LAKES DENTAL

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	9335	CO

General Provider Information

NPI Number	:	1598940785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI LAKES DENTAL

Provider Business Mailing Address
First Line	:	1864 WOODMOOR DR
Second Line	:	SUITE #101
City	:	MONUMENT
State	:	CO
Zip	:	80132-9095
Country	:	US
Telephone Number	:	719-488-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1864 WOODMOOR DR
Second Line	:	SUITE #101
City	:	MONUMENT
State	:	CO
Zip	:	80132-9095
Country	:	US
Telephone Number	:	719-488-5981
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	JAROM LAMOREAUX
Credential	:	DMD
Telephone Number	:	719-488-5981

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

Similar Medicare Providers

1215365994 — SHANNON WRIGHT PMHNP-BC, FNP-C
Practice Location Address:

1864 WOODMOOR DR STE 217
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Practice Phone: 719-631-1605
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1942485131 — KELLY SABRINA LAMOREAUX DMD
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1578716171 — KENNETH DENNIS LPC
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1275875676 — MELISSA R RIESLING MA, LPC
Practice Location Address:

1864 WOODMOOR DR , SUITE 216
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1174299481 — MRS. KAREN L NASH LMFT
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1548121296 — SHANNON WRIGHT PMHNP-BC PLLC
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Directions to “TRI LAKES DENTAL ” Practice Location

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