Organization
ALTITUDE ORAL AND FACIAL COSMETIC SURGERY LONE TREE, PLLC
Active
Parent organization
FANGMAN ORAL AND FACIAL SURGERY PROFESSIONAL LLC
Other names
Robinson and Fangman Cosmetic Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
FANGMAN ORAL AND FACIAL SURGERY PROFESSIONAL LLC
Authorized official
DR. BRAIN J FANGMAN DDS (PRESIDENT CEO)
(614) 354-7468
Entity
Organization
Contact information
Practice address
10375 PARK MEADOWS DR STE 150, LONE TREE, CO 80124-6755
(303) 792-2828
Mailing address
3596 BIRCH AVE, PARKER, CO 80134-9615
(614) 354-7468
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
0202239
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609027556
INDIVIDUAL NPI
NY
05
—
1952791964
—
CO
Enumeration date
01/11/2018
Last updated
04/11/2022
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