MEDICARE: DR. WILLIAM HOLDERBAUM D.D.S.

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	122300000X	Dentist	3749	CO

General Provider Information

NPI Number	:	1649618422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HOLDERBAUM D.D.S.

Provider Business Mailing Address
First Line	:	1870 DUBLIN BLVD
Second Line	:	SUITE D
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1294
Country	:	US
Telephone Number	:	719-528-8282
Fax Number	:	719-528-8286

Provider Business Practice Location Address
First Line	:	1870 DUBLIN BLVD
Second Line	:	SUITE D
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1294
Country	:	US
Telephone Number	:	719-528-8282
Fax Number	:	719-528-8286

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

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	08/06/2013

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