MEDICARE: G & T ENTERPRISES, P.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		CO
2	122300000X	Dentist		CO

General Provider Information

NPI Number	:	1942601034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G & T ENTERPRISES, P.C.

Provider Business Mailing Address
First Line	:	3216 HIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4062
Country	:	US
Telephone Number	:	303-329-0231
Fax Number	:	303-329-4622

Provider Business Practice Location Address
First Line	:	3216 HIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4062
Country	:	US
Telephone Number	:	303-329-0231
Fax Number	:	303-329-4622

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	KIMBERLY MCCLESKEY
Credential	:
Telephone Number	:	303-521-2560

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	09/09/2014

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