# COLORADO PLAINS ORAL & MAXILLOFACIAL SURGERY P.C.

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

## Provider details

- **NPI number:** 1568863223
- **Authorized official:** DR. DANIEL E BOEDEKER DDS (OWNER)
- **Authorized official phone:** (970) 867-4477

## Contact information

- **Practice address:** 527 W PLATTE AVE, FORT MORGAN, CO 80701-2654
- **Practice address phone:** (970) 768-6869
- **Practice address fax:** (970) 867-4499
- **Mailing address:** 527 W PLATTE AVE, FORT MORGAN, CO 80701-2654
- **Mailing address phone:** (970) 768-6869
- **Mailing address fax:** (970) 867-4499

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 10147 | CO | Yes |

## Other

- **Enumeration date:** 09/11/2014
- **Last updated:** 09/11/2014