Provider Demographics
NPI:1891225348
Name:COLORADO SPRINGS ORAL SURGERY
Entity Type:Organization
Organization Name:COLORADO SPRINGS ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:MISS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:OSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-597-4060
Mailing Address - Street 1:3100 N ACADEMY BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5332
Mailing Address - Country:US
Mailing Address - Phone:719-597-4060
Mailing Address - Fax:719-574-2140
Practice Address - Street 1:3100 N ACADEMY BLVD STE 213
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5332
Practice Address - Country:US
Practice Address - Phone:719-597-4060
Practice Address - Fax:719-574-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery