MEDICARE: OA DENTAL LONGMONT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174480347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OA DENTAL LONGMONT PLLC

Provider Business Mailing Address
First Line	:	1818 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3253
Country	:	US
Telephone Number	:	970-239-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3253
Country	:	US
Telephone Number	:	970-239-1514
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	CARLY WOODS
Credential	:
Telephone Number	:	720-280-6584

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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