# CHEYENNE MOUNTAIN ORAL SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHEYENNE MOUNTAIN ORAL SURGERY PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518561364
- **Legal business name:** CHEYENNE MOUNTAIN ORAL SURGERY PC
- **Authorized official:** SANDRA RENEHAN MD (ADMINISTRATOR)
- **Authorized official phone:** (719) 540-6350

## Contact information

- **Practice address:** 640 SOUTHPOINTE CT STE 150, COLORADO SPRINGS, CO 80906-3884
- **Practice address phone:** (719) 540-6350
- **Practice address fax:** (719) 527-9487
- **Mailing address:** 640 SOUTHPOINTE CT STE 150, COLORADO SPRINGS, CO 80906-3884
- **Mailing address phone:** (719) 540-6350
- **Mailing address fax:** (719) 527-9487

## 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:** 11/23/2020
- **Last updated:** 11/23/2020