MEDICARE: ALAN REISMAN, DDS, PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7346	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922361062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN REISMAN, DDS, PC

Provider Business Mailing Address
First Line	:	1075 S BOULDER RD STE 135
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2559
Country	:	US
Telephone Number	:	303-665-2377
Fax Number	:	303-665-1301

Provider Business Practice Location Address
First Line	:	1075 S BOULDER RD STE 135
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2559
Country	:	US
Telephone Number	:	303-665-2377
Fax Number	:	303-665-1301

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALAN JON REISMAN
Credential	:	DDS
Telephone Number	:	303-665-2377

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	06/22/2012

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