# COLORADO SPRINGS ORAL AND FACIAL SURGERY CENTER PLLC

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

## Provider details

- **NPI number:** 1689230104
- **Authorized official:** MIKE COLE (VP INSURNACE PLAN MANAGEMENT)
- **Authorized official phone:** (727) 424-2990

## Contact information

- **Practice address:** 1644 MEDICAL CENTER PT \# 101, COLORADO SPRINGS, CO 80907-5764
- **Practice address phone:** (719) 497-9162
- **Practice address fax:** (719) 597-4060
- **Mailing address:** 1644 MEDICAL CENTER PT STE 101, COLORADO SPRINGS, CO 80907-5765

## 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:** 05/10/2019
- **Last updated:** 11/29/2023