MEDICARE: DENTISTS OF INTERQUEST AND ORTHODONTICS

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1902651318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS OF INTERQUEST AND ORTHODONTICS

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 DEMOCRACY POINT
Second Line	:	SUITE 140
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908
Country	:	US
Telephone Number	:	719-867-4291
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVAN FRAISER
Credential	:
Telephone Number	:	714-845-8500

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	04/19/2024

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Directions to “DENTISTS OF INTERQUEST AND ORTHODONTICS ” Practice Location

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