Organization
LONGMONT ORAL, FACIAL & IMPLANT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE LEOS (PRACTICE ADMINISTRATOR)
(303) 772-8870
Entity
Organization
Contact information
Practice address
1551 PROFESSIONAL LN UNIT 260, LONGMONT, CO 80501-6903
(303) 772-8870
(303) 772-8871
Mailing address
1551 PROFESSIONAL LN UNIT 260, LONGMONT, CO 80501-6903
(303) 772-8870
(303) 772-8871
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DEN.00010071
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DEN.00201841
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386808533
NPI
CO
01
—
1689797243
NPI
CO
Enumeration date
04/04/2017
Last updated
04/04/2017
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