# FANGMAN & IVEY ORAL AND FACIAL SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Altitude Oral and Facial Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275120495
- **Authorized official:** DR. BRIAN JOHN FANGMAN DDS (PRESIDENT/CEO)
- **Authorized official phone:** (720) 328-4990

## Contact information

- **Practice address:** 1440 BLAKE ST STE 100, DENVER, CO 80202-1475
- **Practice address phone:** (720) 328-4990
- **Practice address fax:** (720) 328-4994
- **Mailing address:** 5600 W 44TH AVE STE 100, DENVER, CO 80212-7339
- **Mailing address phone:** (720) 328-4990
- **Mailing address fax:** (720) 328-4994

## Taxonomy

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

## Other

- **Enumeration date:** 12/22/2020
- **Last updated:** 12/22/2020