Provider Demographics
NPI:1326641739
Name:MONTROSE ORAL SURGERY AND MAXILLOFACIAL SPECIALISTS
Entity Type:Organization
Organization Name:MONTROSE ORAL SURGERY AND MAXILLOFACIAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-240-4485
Mailing Address - Street 1:600 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4324
Mailing Address - Country:US
Mailing Address - Phone:970-240-4485
Mailing Address - Fax:970-249-6539
Practice Address - Street 1:600 S PARK AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4324
Practice Address - Country:US
Practice Address - Phone:970-240-4485
Practice Address - Fax:970-249-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1114995222Medicaid
CO1346450111Medicaid