MEDICARE: DR. MARK D. GEORGE D.D.S., MS., P.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6066	CO

General Provider Information

NPI Number	:	1790758555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK D. GEORGE D.D.S., MS., P.C.

Provider Business Mailing Address
First Line	:	7770 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4086
Country	:	US
Telephone Number	:	719-594-9797
Fax Number	:	308-594-6713

Provider Business Practice Location Address
First Line	:	7770 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4087
Country	:	US
Telephone Number	:	719-594-9797
Fax Number	:	308-594-6713

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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