Organization
ORAL AND MAXILLOFACIAL SURGERY OF LONGMONT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS L SQUIRE DDS (OWNER)
(303) 772-8585
Entity
Organization
Contact information
Practice address
1361 FRANCIS STREET, SUITE 101, LONGMONT, CO 80501
(303) 772-8585
(303) 776-4895
Mailing address
1361 FRANCIS STREET, SUITE 101, LONGMONT, CO 80501
(303) 772-8585
(303) 776-4895
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8762
CO
Other
Enumeration date
04/18/2008
Last updated
04/18/2008
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