Provider Demographics
NPI:1376663641
Name:ORAL SURGERY ASSOCIATES OF COLORADO SPRINGS, P.C.
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF COLORADO SPRINGS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAR-DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-473-2650
Mailing Address - Street 1:5745 ERINDALE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8902
Mailing Address - Country:US
Mailing Address - Phone:719-473-2650
Mailing Address - Fax:719-473-2508
Practice Address - Street 1:5745 ERINDALE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8902
Practice Address - Country:US
Practice Address - Phone:719-473-2650
Practice Address - Fax:719-473-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty