# CHERRY CREEK ORAL & MAXILLOFACIAL SURGERY, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043373004
- **Authorized official:** DR. CLYDE E WAGGONER DMD (PRESIDENT)
- **Authorized official phone:** (303) 777-1603

## Contact information

- **Practice address:** 3955 E EXPOSITION AVE, SUITE 520, DENVER, CO 80209-5000
- **Practice address phone:** (303) 777-1603
- **Mailing address:** 3955 E EXPOSITION AVE, SUITE 520, DENVER, CO 80209-5000
- **Mailing address phone:** (303) 777-1603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7506 | CO | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 08/22/2020