Healthcare Provider Details

I. General information

NPI: 1902407968
Provider Name (Legal Business Name): FACIAL PLASTIC SURGERY CENTER OF COLORADO SPRINGS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 PULPIT PEAK VW
COLORADO SPRINGS CO
80918-3954
US

IV. Provider business mailing address

6 ELM AVE
COLORADO SPRINGS CO
80906-3130
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5020
  • Fax: 719-520-5488
Mailing address:
  • Phone: 706-632-7429
  • Fax: 970-342-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS ANDREW DALSASO
Title or Position: OWNER
Credential: MD
Phone: 719-632-5020