Healthcare Provider Details

I. General information

NPI: 1881948651
Provider Name (Legal Business Name): HIGHLANDS RANCH CENTER FOR AESTHETIC & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COUNTY LINE RD SUITE 230
HIGHLANDS RANCH CO
80129-2360
US

IV. Provider business mailing address

200 W COUNTY LINE RD SUITE 230
HIGHLANDS RANCH CO
80129-2360
US

V. Phone/Fax

Practice location:
  • Phone: 303-791-0422
  • Fax: 303-791-0564
Mailing address:
  • Phone: 303-791-0422
  • Fax: 303-791-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7009
License Number StateCO

VIII. Authorized Official

Name: DR. STEPHEN JAMES COLM
Title or Position: OWNER
Credential: D.M.D
Phone: 303-791-0422