Healthcare Provider Details

I. General information

NPI: 1609716646
Provider Name (Legal Business Name): ASSOCIATES IN MAXILLOFACIAL AND ORAL SURGERY PLLC - CASTLE ROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MALETA LN
CASTLE ROCK CO
80108-7610
US

IV. Provider business mailing address

1755 TELSTAR DR STE 210
COLORADO SPRINGS CO
80920-1018
US

V. Phone/Fax

Practice location:
  • Phone: 303-217-8017
  • Fax: 719-599-0575
Mailing address:
  • Phone: 719-599-0500
  • Fax: 719-599-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ANGEL GIMENEZ
Title or Position: CREDENTIALING SENIOR MANAGER
Credential:
Phone: 719-300-5933