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Organization
SQUIRE ORAL, FACIAL & DENTAL IMPLANT SURGERY
Active
Organization
SQUIRE ORAL, FACIAL & DENTAL IMPLANT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY K MATZ (DENTAL FACILITATOR)
(303) 772-8585
Entity
Organization
Contact information
Practice address
1361 FRANCIS ST. STE. 101, LONGMONT, CO 80501
(303) 772-8585
Mailing address
1325 HOVER ST. STE. 101, LONGMONT, CO 80501
(303) 772-8585
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8762
CO
Other
Enumeration date
10/19/2011
Last updated
10/19/2011
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