MEDICARE: DENVER METRO OMS PC

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	174400000X	Specialist
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1912060450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER METRO OMS PC

Provider Business Mailing Address
First Line	:	4500 E CHERRY CREEK SOUTH DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-1518
Country	:	US
Telephone Number	:	303-321-0333
Fax Number	:	303-393-0617

Provider Business Practice Location Address
First Line	:	4500 E CHERRY CREEK SOUTH DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-1518
Country	:	US
Telephone Number	:	303-321-0333
Fax Number	:	303-393-0617

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MICHELLE A CLINE
Credential	:
Telephone Number	:	303-321-0333

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/10/2020

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Directions to “DENVER METRO OMS PC ” Practice Location

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