Healthcare Provider Details

I. General information

NPI: 1831332857
Provider Name (Legal Business Name): ROCKY MOUNTAIN ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 E HAMPDEN AVE SUITE 202
DENVER CO
80224-3024
US

IV. Provider business mailing address

6850 E HAMPDEN AVE SUITE 202
DENVER CO
80224-3024
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-6850
  • Fax: 303-758-0729
Mailing address:
  • Phone: 303-758-6850
  • Fax: 303-758-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEVEN RICHARD NELSON
Title or Position: PARTNER/ORAL SURGEON
Credential: D.D.S.,M.S.
Phone: 303-758-6850