# SQUIRE ORAL, FACIAL & DENTAL IMPLANT SURGERY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1396020657
- **Authorized official:** SHERRY K MATZ (DENTAL FACILITATOR)
- **Authorized official phone:** (303) 772-8585

## Contact information

- **Practice address:** 1361 FRANCIS ST. STE. 101, LONGMONT, CO 80501
- **Practice address phone:** (303) 772-8585
- **Mailing address:** 1325 HOVER ST. STE. 101, LONGMONT, CO 80501
- **Mailing address phone:** (303) 772-8585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 8762 | CO | Yes |

## Other

- **Enumeration date:** 10/19/2011
- **Last updated:** 10/19/2011