# ROCKY MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PROF LLC

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

## Provider details

- **NPI number:** 1366126583
- **Authorized official:** MICHAEL ROLLERT DDS (PRESIDENT DENTIST)
- **Authorized official phone:** (720) 452-2144

## Contact information

- **Practice address:** 2750 E 136TH AVE STE 101, THORNTON, CO 80241-3530
- **Practice address phone:** (720) 452-2144
- **Practice address fax:** (303) 379-9051
- **Mailing address:** 2750 E 136TH AVE STE 101, THORNTON, CO 80241-3530
- **Mailing address phone:** (720) 452-2144
- **Mailing address fax:** (303) 379-9051

## 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:** 06/09/2023
- **Last updated:** 06/09/2023