=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184581779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE SKY ORAL AND MAXILLOFACIAL SURGERY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1707 61ST AVE STE 102
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80634-7997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-506-0350
-----------------------------------------------------
Fax | 970-506-0352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 61ST AVE STE 102
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80634-7997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-506-0350
-----------------------------------------------------
Fax | 970-506-0352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. DAVID THURGOOD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 970-506-0350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------