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Organization
LONGMONT ORAL, FACIAL & IMPLANT SURGERY
Active
Organization
LONGMONT ORAL, FACIAL & IMPLANT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE LEOS (PRACTICE ADMINISTRATOR)
(303) 772-8870
Entity
Organization
Contact information
Practice address
1551 PROFESSIONAL LN UNIT 260, LONGMONT, CO 80501-6903
(303) 772-8870
(303) 772-8871
Mailing address
1551 PROFESSIONAL LN UNIT 260, LONGMONT, CO 80501-6903
(303) 772-8870
(303) 772-8871
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DEN.00010071
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DEN.00201841
CO
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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