MEDICARE: PLATTEVILLE FAMILY DENTISTRY

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	261QD0000X	Dental Clinic/Center	10088	CO

General Provider Information

NPI Number	:	1730433889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATTEVILLE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	417 BLUE LAKE TRL
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8893
Country	:	US
Telephone Number	:	970-590-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 JUSTIN AVE
Second Line	:	SUITE 120
City	:	PLATTEVILLE
State	:	CO
Zip	:	80651-7800
Country	:	US
Telephone Number	:	970-590-6205
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BETH ANN DORIAN
Credential	:	DMD
Telephone Number	:	970-590-6205

Provider Enumeration Date	:	10/27/2012
Last Update Date	:	10/27/2012

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Directions to “PLATTEVILLE FAMILY DENTISTRY ” Practice Location

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