Healthcare Provider Details

I. General information

NPI: 1912060450
Provider Name (Legal Business Name): DENVER METRO OMS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E CHERRY CREEK SOUTH DR
DENVER CO
80246-1518
US

IV. Provider business mailing address

4500 E CHERRY CREEK SOUTH DR
DENVER CO
80246-1518
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-0333
  • Fax: 303-393-0617
Mailing address:
  • Phone: 303-321-0333
  • Fax: 303-393-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE A CLINE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-321-0333