MEDICARE: GOITOM TESFALDET

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	124Q00000X	Dental Hygienist	DH.000905892	CO

General Provider Information

NPI Number	:	1639599087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GOITOM TESFALDET

Provider Business Mailing Address
First Line	:	9073 E OXFORD DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1922
Country	:	US
Telephone Number	:	720-579-4871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 E COLFAX AVE STE 301
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2216
Country	:	US
Telephone Number	:	303-832-8655
Fax Number	:

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

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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Directions to “ GOITOM TESFALDET ” Practice Location

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