Cherry Creek Oral & Maxillofacial Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7506 Issued in CO

Legal business name

CHERRY CREEK ORAL & MAXILLOFACIAL SURGERY, PC

Practice address

3955 E Exposition Ave
Suite 520
Denver, CO 80209-5000

Phone

(303) 777-1603

NPI assigned

Dec 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clyde E Waggoner, DMD

Title

President

Phone

(303) 777-1603

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043373004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 E EXPOSITION AVE",
            "address_2": "SUITE 520",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802095000",
            "telephone_number": "303-777-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 E EXPOSITION AVE",
            "address_2": "SUITE 520",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802095000",
            "telephone_number": "303-777-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY CREEK ORAL & MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-777-1603",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "7506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cherry Creek Family Practice PLLC
• Cherry Creek Medical Group
• Cherry Creek Neurology
• Cherry Creek Nutrition
• Cherry Creek Optical
• Cherry Creek Pediatrics, PC
• Cherry Creek Physical Therapy
• Cherry Creek Restorative Dentistry
• Cherry Creek School District No. 5
• Cherry Creek South Dentistry

• Oral and Maxillofacial Surgery (Dentist) in Denver, CO
• Providers in Denver, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.