# CHEYENNE MOUNTAIN ORAL SURGERY PC

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

## Provider details

- **NPI number:** 1689167280
- **Authorized official:** DAYNE JENSEN (OWNER)
- **Authorized official phone:** (720) 603-4800

## Contact information

- **Practice address:** 640 SOUTHPOINTE CT STE 150, COLORADO SPRINGS, CO 80906-3884
- **Practice address phone:** (720) 603-4800
- **Mailing address:** 4643 S ULSTER ST STE 300, DENVER, CO 80237-3028

## 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:** 06/08/2018
- **Last updated:** 06/08/2018