MEDICARE: SECURITY DENTAL PARTNERS

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	203027	CO
2	1223G0001X	General Practice Dentistry	9433	CO

General Provider Information

NPI Number	:	1700322799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURITY DENTAL PARTNERS

Provider Business Mailing Address
First Line	:	332 MAIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1713
Country	:	US
Telephone Number	:	720-907-0683
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 MAIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1713
Country	:	US
Telephone Number	:	720-907-0683
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JESS ADAMS
Credential	:	DDS
Telephone Number	:	720-907-0683

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	03/29/2017

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Directions to “SECURITY DENTAL PARTNERS ” Practice Location

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