MEDICARE: EGBERT AND STILSON DENTAL PLLC

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	00202336	CO
2	122300000X	Dentist	00009216	CO

General Provider Information

NPI Number	:	1881119220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EGBERT AND STILSON DENTAL PLLC

Provider Business Mailing Address
First Line	:	9680 NAUTILUS PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-8706
Country	:	US
Telephone Number	:	719-494-2865
Fax Number	:	719-282-6091

Provider Business Practice Location Address
First Line	:	9680 NAUTILUS PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-8706
Country	:	US
Telephone Number	:	719-494-2865
Fax Number	:	719-282-6091

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BOBBIE WILSON
Credential	:
Telephone Number	:	719-494-2865

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	08/02/2024

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