MEDICARE: DR. AARON PAUL VAN WYK 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	122300000X	Dentist	DEN.00202318	CO

General Provider Information

NPI Number	:	1689082810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON PAUL VAN WYK DDS

Provider Business Mailing Address
First Line	:	220 E ROGERS RD
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6027
Country	:	US
Telephone Number	:	303-772-1906
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 S ROLLIE AVE
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1508
Country	:	US
Telephone Number	:	303-286-4560
Fax Number	:	303-286-4589

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	08/25/2014

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