MEDICARE: BIRD AND WITTENBERG DENTAL PARTNERSHIP

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	5111	CO
2	1223G0001X	General Practice Dentistry	6775	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	823010	OTHER		UNITED CONCORDIA DR BIRD
2	777871	OTHER		UNITED CONCORDIA DR W

General Provider Information

NPI Number	:	1962483776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRD AND WITTENBERG DENTAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	7222 COMMERCE CENTER DR
Second Line	:	STE 247
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919
Country	:	US
Telephone Number	:	719-593-0403
Fax Number	:	719-593-0767

Provider Business Practice Location Address
First Line	:	7222 COMMERCE CENTER DR
Second Line	:	STE 247
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919
Country	:	US
Telephone Number	:	719-593-0403
Fax Number	:	719-593-0767

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDD B WITTENBERG
Credential	:	DDS
Telephone Number	:	719-593-0403

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/22/2020

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Directions to “BIRD AND WITTENBERG DENTAL PARTNERSHIP ” Practice Location

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