Provider Demographics
NPI:1710763495
Name:ASSOCIATES IN MAXILLOFACIAL AND ORAL SURGERY, PLLC
Entity Type:Organization
Organization Name:ASSOCIATES IN MAXILLOFACIAL AND ORAL SURGERY, PLLC
Other - Org Name:AMOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORGANISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-300-5933
Mailing Address - Street 1:320 E FONTANERO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7525
Mailing Address - Country:US
Mailing Address - Phone:719-599-0500
Mailing Address - Fax:719-599-0575
Practice Address - Street 1:320 E FONTANERO ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7525
Practice Address - Country:US
Practice Address - Phone:719-599-0500
Practice Address - Fax:719-599-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty