Provider Demographics
NPI:1811199920
Name:ADVANCED ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:ADVANCED ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LESSIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-768-8570
Mailing Address - Street 1:9094 E MINERAL CIR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7200
Mailing Address - Country:US
Mailing Address - Phone:303-768-8570
Mailing Address - Fax:303-768-8572
Practice Address - Street 1:10120 E DRY CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-2772
Practice Address - Country:US
Practice Address - Phone:303-768-8570
Practice Address - Fax:303-768-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71980857Medicaid