Provider Demographics
NPI:1346484193
Name:COLORADO REGIONAL ORAL SURGERY
Entity type:Organization
Organization Name:COLORADO REGIONAL ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:303-431-0033
Mailing Address - Street 1:8025 CLUB CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005
Mailing Address - Country:US
Mailing Address - Phone:303-431-0033
Mailing Address - Fax:303-431-0507
Practice Address - Street 1:8025 CLUB CREST DRIVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005
Practice Address - Country:US
Practice Address - Phone:303-431-0033
Practice Address - Fax:303-431-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07961223S0112X, 261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Multi-Specialty