# ORAL SURGERY SPECIALISTS OF PUEBLO, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ORAL SURGERY SPECIALISTS OF PUEBLO
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619405396
- **Authorized official:** MR. TYLER E NELSON DDS (OWNER)
- **Authorized official phone:** (719) 597-4060

## Contact information

- **Practice address:** 3691 PARKER BLVD, PUEBLO, CO 81008-2278
- **Practice address phone:** (719) 212-0777
- **Mailing address:** 3100 N ACADEMY BLVD STE 213, COLORADO SPRINGS, CO 80917-5332
- **Mailing address phone:** (719) 597-4060
- **Mailing address fax:** (719) 574-2140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/25/2017
- **Last updated:** 05/25/2017