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General NPI Number Information
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NPI Number | 1518744416
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PROF LLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 10375 PARK MEADOWS DR STE 150
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City | LONE TREE
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State | CO
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Zip | 80124-6755
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Country | US
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Telephone | 720-452-2144
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Fax | 303-379-9051
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Provider Business Mailing Address
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Address Line | 2750 E 136TH AVE STE 101
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City | THORNTON
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State | CO
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Zip | 80241-3530
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Country | US
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Telephone | 720-452-2144
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Fax | 303-379-9051
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MICHAEL ROLLERT
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Credential | DDS
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Telephone | 303-503-5039
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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 |
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License Number State |
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