Provider Demographics
NPI:1336914282
Name:COLORADO ORAL AND FACIAL COSMETIC SURGERY, PLLC
Entity type:Organization
Organization Name:COLORADO ORAL AND FACIAL COSMETIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FATHIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS FACS
Authorized Official - Phone:303-381-7101
Mailing Address - Street 1:10535 PARK MEADOWS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-8401
Mailing Address - Country:US
Mailing Address - Phone:303-381-7101
Mailing Address - Fax:
Practice Address - Street 1:10535 PARK MEADOWS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-8401
Practice Address - Country:US
Practice Address - Phone:303-381-7101
Practice Address - Fax:303-381-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery