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General NPI Number Information
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NPI Number | 1639470941
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Entity Type | Organization
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Legal Business Name | NORTH DENVER ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 12213 PECOS ST # 100
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City | WESTMINSTER
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State | CO
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Zip | 80234-3425
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Country | US
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Telephone | 303-255-0500
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Fax | 303-255-0900
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Provider Business Mailing Address
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Address Line | 12213 PECOS ST # 100
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City | WESTMINSTER
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State | CO
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Zip | 80234-3425
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Country | US
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Telephone | 303-255-0500
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Fax | 303-255-0900
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS HONG
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Credential | DMD, MD
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Telephone | 303-255-0500
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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 | 46207
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License Number State | CO
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