Provider Demographics
NPI:1215659206
Name:FORT COLLINS ORAL & MAXILLOFACIAL SURGERY PARTNERSHIP
Entity type:Organization
Organization Name:FORT COLLINS ORAL & MAXILLOFACIAL SURGERY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:970-225-9555
Mailing Address - Street 1:2014 CARIBOU DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4330
Mailing Address - Country:US
Mailing Address - Phone:970-225-9555
Mailing Address - Fax:
Practice Address - Street 1:2014 CARIBOU DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4330
Practice Address - Country:US
Practice Address - Phone:970-225-9555
Practice Address - Fax:970-223-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225484629OtherOTHER PROVIDE NPI