Provider Demographics
NPI:1740092964
Name:ASSOCIATES IN MAXILLOFACIAL AND ORAL SURGERY, PLLC
Entity type:Organization
Organization Name:ASSOCIATES IN MAXILLOFACIAL AND ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-300-5933
Mailing Address - Street 1:1755 TELSTAR DR STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1018
Mailing Address - Country:US
Mailing Address - Phone:719-599-0500
Mailing Address - Fax:
Practice Address - Street 1:25 N SPRUCE ST STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1446
Practice Address - Country:US
Practice Address - Phone:719-599-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATES IN MAXILLOFACIAL AND ORAL SURGERY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty