MEDICARE: DR. JEFFREY NOLAN BOURNE DDS

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	8609	CO

General Provider Information

NPI Number	:	1912908153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY NOLAN BOURNE DDS

Provider Business Mailing Address
First Line	:	11780 MILL VALLEY ST
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80138-8793
Country	:	US
Telephone Number	:	303-549-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	15425 E ILIFF AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-1034
Country	:	US
Telephone Number	:	303-755-5768
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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