Provider Demographics
NPI:1902407968
Name:FACIAL PLASTIC SURGERY CENTER OF COLORADO SPRINGS, PC
Entity Type:Organization
Organization Name:FACIAL PLASTIC SURGERY CENTER OF COLORADO SPRINGS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DALSASO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-632-5020
Mailing Address - Street 1:6 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3130
Mailing Address - Country:US
Mailing Address - Phone:706-632-7429
Mailing Address - Fax:970-342-2093
Practice Address - Street 1:5623 PULPIT PEAK VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3954
Practice Address - Country:US
Practice Address - Phone:719-632-5020
Practice Address - Fax:719-520-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty