# COLORADO REGIONAL ORAL SURGERY

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

## Provider details

- **NPI number:** 1346484193
- **Authorized official:** MRS. DIANE M CORONA LPN (OFFICE MANAGER)
- **Authorized official phone:** (303) 431-0033

## Contact information

- **Practice address:** 8025 CLUB CREST DRIVE, ARVADA, CO 80005
- **Practice address phone:** (303) 431-0033
- **Practice address fax:** (303) 431-0507
- **Mailing address:** 8025 CLUB CREST DRIVE, ARVADA, CO 80005
- **Mailing address phone:** (303) 431-0033
- **Mailing address fax:** (303) 431-0507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0796 | CO | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | 0796 | CO | — |

## Other

- **Enumeration date:** 04/23/2009
- **Last updated:** 04/23/2009