MEDICARE: DR. GREGG HAL KALBFLEISCH 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	H-D-1-00226	CO

General Provider Information

NPI Number	:	1639221336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG HAL KALBFLEISCH DDS

Provider Business Mailing Address
First Line	:	8006 FOX HILL DR
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-5254
Country	:	US
Telephone Number	:	303-772-3696
Fax Number	:	303-776-4895

Provider Business Practice Location Address
First Line	:	1361 FRANCIS ST
Second Line	:	SUITE 101
City	:	LONGMONT
State	:	CO
Zip	:	80501-2576
Country	:	US
Telephone Number	:	303-772-8585
Fax Number	:	303-776-4895

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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