Provider Demographics
NPI:1922399120
Name:TOMASETTI, MCLAIN AND PLEVNIA ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:TOMASETTI, MCLAIN AND PLEVNIA ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-840-2300
Mailing Address - Street 1:7889 S LINCOLN CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2651
Mailing Address - Country:US
Mailing Address - Phone:303-798-4553
Mailing Address - Fax:
Practice Address - Street 1:7889 S LINCOLN CT
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2651
Practice Address - Country:US
Practice Address - Phone:303-798-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02005981Medicaid
COCB1815OtherMEDICARE PTAN BOYD TOMASETTI
CO306646OtherMEDICARE PTAN
CO82174831Medicaid