Healthcare Provider Details

I. General information

NPI: 1386266070
Provider Name (Legal Business Name): BLUE SKY OMS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 61ST AVE STE 102
GREELEY CO
80634-7997
US

IV. Provider business mailing address

1707 61ST AVE STE 102
GREELEY CO
80634-7997
US

V. Phone/Fax

Practice location:
  • Phone: 970-506-0350
  • Fax:
Mailing address:
  • Phone: 970-506-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID THURGOOD
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 970-506-0350