Healthcare Provider Details

I. General information

NPI: 1639470941
Provider Name (Legal Business Name): NORTH DENVER ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12213 PECOS ST # 100
WESTMINSTER CO
80234-3425
US

IV. Provider business mailing address

12213 PECOS ST # 100
WESTMINSTER CO
80234-3425
US

V. Phone/Fax

Practice location:
  • Phone: 303-255-0500
  • Fax: 303-255-0900
Mailing address:
  • Phone: 303-255-0500
  • Fax: 303-255-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number46207
License Number StateCO

VIII. Authorized Official

Name: DOUGLAS HONG
Title or Position: OWNER
Credential: DMD, MD
Phone: 303-255-0500