MEDICARE: JASON M SPYCHALA 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	1223G0001X	General Practice Dentistry	D12394	MN

General Provider Information

NPI Number	:	1720286719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M SPYCHALA DDS

Provider Business Mailing Address
First Line	:	311 1ST ST N
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-1611
Country	:	US
Telephone Number	:	320-685-8891
Fax Number	:	320-685-5321

Provider Business Practice Location Address
First Line	:	311 1ST ST N
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-1611
Country	:	US
Telephone Number	:	320-685-8891
Fax Number	:	320-685-5321

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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