MEDICARE: DR. JOSHUA GOTLIB D.D.S, M.S.

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	201935	CO

General Provider Information

NPI Number	:	1831534262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA GOTLIB D.D.S, M.S.

Provider Business Mailing Address
First Line	:	3952 N ACADEMY BLVD STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3952 N ACADEMY BLVD STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5910
Country	:	US
Telephone Number	:	719-622-1225
Fax Number	:

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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