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General NPI Number Information
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NPI Number | 1295271450
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Entity Type | Organization
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Legal Business Name | ASPEN ORAL AND FACIAL SURGERY, PLLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 671 MITCHELL WAY SUITE 100
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City | ERIE
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State | CO
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Zip | 80516
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Country | US
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Telephone | 720-990-0381
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Fax |
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Provider Business Mailing Address
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Address Line | 671 MITCHELL WAY SUITE 100
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City | ERIE
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State | CO
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Zip | 80516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGENE C KANG
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Credential | MD, DMD
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Telephone | 720-990-0381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 55871
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 202361
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License Number State | CO
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