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General NPI Number Information
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NPI Number | 1922680388
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS ORAL AND FACIAL SURGERY CENTER PLLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 13540 MEADOWGRASS DR STE 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3012
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Country | US
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Telephone | 719-286-9725
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Fax |
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Provider Business Mailing Address
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Address Line | 13540 MEADOWGRASS DR STE 215
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3012
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Country | US
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Telephone | 719-286-9725
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Fax |
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Authorized Official
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Title or Position | VP INSURANCE PLAN MANAGEMENT
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Name | MIKE COLE
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Credential |
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Telephone | 727-424-2990
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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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