| Fangman & Ivey Oral And Facial Surgery Pllc | |
|
1440 Blake St Ste 100 Denver CO 80202-1475 | |
| (720) 328-4990 | |
| (720) 328-4994 |
| Full Name | Fangman & Ivey Oral And Facial Surgery Pllc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1440 Blake St Ste 100, Denver, Colorado |
| Authorized Official Name and Position | Brian John Fangman (PRESIDENT/CEO) |
| Authorized Official Contact | 7203284990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fangman & Ivey Oral And Facial Surgery Pllc 5600 W 44th Ave Ste 100 Denver CO 80212-7339 Ph: (720) 328-4990 | Fangman & Ivey Oral And Facial Surgery Pllc 1440 Blake St Ste 100 Denver CO 80202-1475 Ph: (720) 328-4990 |
| NPI Number | 1275120495 |
|---|---|
| Provider Enumeration Date | 12/22/2020 |
| Last Update Date | 12/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275120495 | NPI | - | NPPES |
| 1952791964 | Medicaid | CO | |
| 1013358985 | Other | TX | INDIVIDUAL NPI |
| 1609027556 | Other | NY | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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