MEDICARE: BC FACIAL SURGERY, 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1992412316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BC FACIAL SURGERY, PLLC

Provider Business Mailing Address
First Line	:	1176 ALOHA ST STE 200
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-2836
Country	:	US
Telephone Number	:	303-219-2119
Fax Number	:	303-219-8978

Provider Business Practice Location Address
First Line	:	1176 ALOHA ST STE 200
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-2836
Country	:	US
Telephone Number	:	303-219-2119
Fax Number	:	303-219-8978

Authorized Official
Title or Position	:	OWNER
Name	:	BRYAN YOUNG CHAI
Credential	:	DDS, PHD
Telephone Number	:	303-219-2119

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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