Provider Demographics
NPI:1891200309
Name:HIGHLANDS RANCH ORAL & FACIAL SURGERY
Entity Type:Organization
Organization Name:HIGHLANDS RANCH ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-996-0210
Mailing Address - Street 1:300 PLAZA DR STE 175
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2335
Mailing Address - Country:US
Mailing Address - Phone:720-996-0210
Mailing Address - Fax:720-996-0211
Practice Address - Street 1:300 PLAZA DR STE 175
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2335
Practice Address - Country:US
Practice Address - Phone:720-996-0210
Practice Address - Fax:720-996-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery