MEDICARE: DR. RYAN MARK PFEIFER 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.00202006	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730434622	OTHER	CO	OFFICE NPI (FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS)

General Provider Information

NPI Number	:	1770922023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MARK PFEIFER DDS

Provider Business Mailing Address
First Line	:	90 WATCH HILL DR APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7939
Country	:	US
Telephone Number	:	785-650-7964
Fax Number	:

Provider Business Practice Location Address
First Line	:	6940 MESA RIDGE PKWY
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1533
Country	:	US
Telephone Number	:	719-382-4936
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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