Organization
COLORADO FACIAL PLASTIC SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO J IMOLA MD, DDS (OWNER)
(303) 839-7980
Entity
Organization
Contact information
Practice address
3600 S LOGAN ST, SUITE 100, ENGLEWOOD, CO 80113-3766
(303) 839-7980
(303) 839-7936
Mailing address
3600 S LOGAN ST, SUITE 100, ENGLEWOOD, CO 80113-3766
(303) 839-7980
(303) 839-7936
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
38335
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08671281
—
CO
01
—
IM642698
BCBS
CO
Enumeration date
02/09/2007
Last updated
03/01/2016
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