Organization
FANGMAN ORAL AND FACIAL SURGERY PROFESSIONAL LLC
Active
Other names
Altitude Oral & Facial Surgery PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN J FANGMAN (DDS)
(614) 354-7468
Entity
Organization
Contact information
Practice address
1555 MAIN ST UNIT A2, WINDSOR, CO 80550-5999
(720) 328-4990
(720) 328-4994
Mailing address
5600 W 44TH AVE STE 100, DENVER, CO 80212-7339
(720) 328-4990
(720) 328-4994
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609027556
INDIVIDUAL NPI
NY
05
—
82781257
—
CO
Enumeration date
03/07/2022
Last updated
04/11/2022
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