Healthcare Provider Details

I. General information

NPI: 1093469447
Provider Name (Legal Business Name): FANGMAN ORAL AND FACIAL SURGERY PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5600 W 44TH AVE UNIT 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 TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN FANGMAN
Title or Position: OWNER/ORAL SURGEON
Credential: DDS
Phone: 720-328-4990