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General NPI Number Information
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NPI Number | 1326321282
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Entity Type | Organization
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Legal Business Name | ADVANCED ORAL & MAXILLOFACIAL SURGERY CENTER
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 6160 TUTT BLVD SUITE 250
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-3500
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Country | US
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Telephone | 719-359-8652
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Fax | 719-623-5771
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Provider Business Mailing Address
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Address Line | 6160 TUTT BLVD SUITE 250
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-3500
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Country | US
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Telephone | 719-359-8652
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Fax | 719-623-5771
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Authorized Official
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Title or Position | OWNER
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Name | DR. RHETT MARVIN QUIST
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Credential | DDS
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Telephone | 719-359-8652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8040
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License Number State | CO
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