MEDICARE: HE DENTTECH, PLLC

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	8566	CO

General Provider Information

NPI Number	:	1962642256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HE DENTTECH, PLLC

Provider Business Mailing Address
First Line	:	2376 RUSTY RIDGE CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2086
Country	:	US
Telephone Number	:	719-487-8961
Fax Number	:

Provider Business Practice Location Address
First Line	:	7750 N UNION BLVD
Second Line	:	STE.101
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4051
Country	:	US
Telephone Number	:	719-598-1293
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. THOMAS RICHARD BAUMGARDNER JR.
Credential	:	D.M.D.
Telephone Number	:	719-487-8961

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	02/25/2009

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