MEDICARE: DOUGLAS S. HONG DMD, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9253	CO

General Provider Information

NPI Number	:	1801980388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS S. HONG DMD, MD

Provider Business Mailing Address
First Line	:	12213 PECOS ST SUITE #100
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234
Country	:	US
Telephone Number	:	303-255-0500
Fax Number	:	303-255-9500

Provider Business Practice Location Address
First Line	:	12213 PECOS ST STE 100
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3414
Country	:	US
Telephone Number	:	303-255-0500
Fax Number	:	303-255-0900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/17/2017

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