Provider Demographics
NPI:1114291887
Name:FRONTIER ORAL SURGERY AND IMPLANT CENTER
Entity Type:Organization
Organization Name:FRONTIER ORAL SURGERY AND IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:307-514-9233
Mailing Address - Street 1:7209 COMMONS CIR
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2644
Mailing Address - Country:US
Mailing Address - Phone:307-514-9233
Mailing Address - Fax:800-952-8830
Practice Address - Street 1:7209 COMMONS CIR
Practice Address - Street 2:UNIT A
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2644
Practice Address - Country:US
Practice Address - Phone:307-514-9233
Practice Address - Fax:800-952-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty