Organization
CHERRY CREEK ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLYDE E WAGGONER DMD (PRESIDENT)
(303) 777-1603
Entity
Organization
Contact information
Practice address
3955 E EXPOSITION AVE, SUITE 520, DENVER, CO 80209-5000
(303) 777-1603
Mailing address
3955 E EXPOSITION AVE, SUITE 520, DENVER, CO 80209-5000
(303) 777-1603
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7506
CO
Other
Enumeration date
12/19/2006
Last updated
08/22/2020
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