Healthcare Provider Details

I. General information

NPI: 1023604535
Provider Name (Legal Business Name): FANGMAN & IVEY ORAL AND FACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5600 W 44TH AVE STE 100
DENVER CO
80212-7339
US

IV. Provider business mailing address

5600 W 44TH AVE STE 100
DENVER CO
80212-7339
US

V. Phone/Fax

Practice location:
  • Phone: 720-328-4990
  • Fax: 720-328-4994
Mailing address:
  • Phone: 720-328-4990
  • Fax: 720-328-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN JOHN FANGMAN
Title or Position: PRESIDENT/CEO
Credential: DDS
Phone: 720-328-4990