MEDICARE: BERT LLOYD MOFFITT D.D.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	122300000X	Dentist	05453	CO

General Provider Information

NPI Number	:	1932169513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERT LLOYD MOFFITT D.D.S.

Provider Business Mailing Address
First Line	:	5068 W 92ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-6302
Country	:	US
Telephone Number	:	303-426-0023
Fax Number	:	303-426-4026

Provider Business Practice Location Address
First Line	:	5068 W 92ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-6302
Country	:	US
Telephone Number	:	303-426-0023
Fax Number	:	303-426-4026

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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