Healthcare Provider Details

I. General information

NPI: 1508541632
Provider Name (Legal Business Name): OKLAND FACIAL PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E MEXICO AVE STE 501
DENVER CO
80210-3943
US

IV. Provider business mailing address

3900 E MEXICO AVE STE 501
DENVER CO
80210-3943
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-5974
  • Fax: 720-817-0335
Mailing address:
  • Phone: 720-583-5974
  • Fax: 720-817-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER S OKLAND
Title or Position: SOLE MEMBER
Credential: MD
Phone: 720-583-5974