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General NPI Number Information
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NPI Number | 1063900231
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Entity Type | Organization
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Legal Business Name | COLORADO MAXILLOFACIAL AND ORAL SURGEONS
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 4105 BRIARGATE PKWY STE 240
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7844
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Country | US
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Telephone | 719-310-7670
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Fax | 719-666-1212
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Provider Business Mailing Address
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Address Line | 4105 BRIARGATE PKWY STE 240
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7844
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Country | US
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Telephone | 719-310-7670
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Fax | 719-666-1212
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Authorized Official
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Title or Position | OWNER
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Name | DR. REBECCA FACY
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Credential | DDS, MD
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Telephone | 719-555-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 00008955
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License Number State | CO
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