# LONGMONT ORAL, FACIAL & IMPLANT SURGERY

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

## Provider details

- **NPI number:** 1366975765
- **Authorized official:** JAMIE LEOS (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (303) 772-8870

## Contact information

- **Practice address:** 1551 PROFESSIONAL LN UNIT 260, LONGMONT, CO 80501-6903
- **Practice address phone:** (303) 772-8870
- **Practice address fax:** (303) 772-8871
- **Mailing address:** 1551 PROFESSIONAL LN UNIT 260, LONGMONT, CO 80501-6903
- **Mailing address phone:** (303) 772-8870
- **Mailing address fax:** (303) 772-8871

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DEN.00010071 | CO | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DEN.00201841 | CO | — |

## Other

- **Enumeration date:** 04/04/2017
- **Last updated:** 04/04/2017