| Oral And Maxillofacial Specialist Pc. | |
|
7730 N Union Blvd Suite 103 Colorado Springs CO 80920-4084 | |
| (719) 590-1500 | |
| (719) 590-9379 |
| Full Name | Oral And Maxillofacial Specialist Pc. |
|---|---|
| Speciality | Dentist |
| Location | 7730 N Union Blvd, Colorado Springs, Colorado |
| Authorized Official Name and Position | Ronald D Thoman (PRESIDENT) |
| Authorized Official Contact | 7195901500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral And Maxillofacial Specialist Pc. 7730 N Union Blvd Suite 103 Colorado Springs CO 80920-4084 Ph: (719) 590-1500 | Oral And Maxillofacial Specialist Pc. 7730 N Union Blvd Suite 103 Colorado Springs CO 80920-4084 Ph: (719) 590-1500 |
| NPI Number | 1013922475 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 06/20/2008 |
| Medicare PECOS PAC ID | 8527141936 |
|---|---|
| Medicare Enrollment ID | O20080208000083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013922475 | NPI | - | NPPES |
| 04019899 | Medicaid | CO | |
| 811466 | Other | MEDICARE ID-TYPE UNSPECIFIED |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 6376 (Colorado) | Primary |
| Provider Name | Ryan Hambleton |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1316267503 PECOS PAC ID: 3870809932 Enrollment ID: I20150903001856 |
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