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NPI Code Detail

MEDICARE: PINE TOP ORTHODONTICS PC

MEDICARE: PINE TOP ORTHODONTICS 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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1790324770
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE TOP ORTHODONTICS PC
Provider Business Mailing Address
First Line : 9475 BRIAR VILLAGE PT STE 315
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7905
Country : US
Telephone Number : 719-481-9199
Fax Number :
Provider Business Practice Location Address
First Line : 9475 BRIAR VILLAGE PT STE 315
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7905
Country : US
Telephone Number : 719-481-9199
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF CREDENTIALING
Name : FAITH GASKINS
Credential :
Telephone Number : 972-869-3789
Provider Enumeration Date : 12/23/2019
Last Update Date : 12/23/2019

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Directions to “PINE TOP ORTHODONTICS PC ” Practice Location

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