Provider Demographics
NPI:1821146523
Name:WHEAT RIDGE ORAL SURGERY
Entity Type:Organization
Organization Name:WHEAT RIDGE ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-421-4010
Mailing Address - Street 1:7760 W 38TH AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6136
Mailing Address - Country:US
Mailing Address - Phone:303-421-4010
Mailing Address - Fax:303-423-9051
Practice Address - Street 1:7760 W 38TH AVE
Practice Address - Street 2:STE. 102
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6136
Practice Address - Country:US
Practice Address - Phone:303-421-4010
Practice Address - Fax:303-423-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty