MEDICARE: KENNETH O GASPER II DDS PC

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

General Provider Information

NPI Number	:	1720439359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH O GASPER II DDS PC

Provider Business Mailing Address
First Line	:	8610 EXPLORER DR
Second Line	:	#315
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-599-0700
Fax Number	:	719-599-8745

Provider Business Practice Location Address
First Line	:	8610 EXPLORER DR
Second Line	:	#315
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-599-0700
Fax Number	:	719-599-8745

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH O GASPER II
Credential	:	D.D.S.
Telephone Number	:	719-599-0700

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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