MEDICARE: DR. MONALI GAUTAM HALDANKAR D.M.D.

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	10625	KY
2	1223G0001X	General Practice Dentistry	DEN.00204031	CO

General Provider Information

NPI Number	:	1639732217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONALI GAUTAM HALDANKAR D.M.D.

Provider Business Mailing Address
First Line	:	295 E SPEER BLVD APT 237
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3557
Country	:	US
Telephone Number	:	502-471-1321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4919 OUTER LOOP
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-4051
Country	:	US
Telephone Number	:	303-697-2583
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	08/16/2021

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