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

Last updated

Aug 22, 2020By the provider in NPPES

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, DMDNPI 1881757854

Title

President

Phone

(303) 777-1603

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clyde E Waggoner, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Denver, CO
  • NPI 1881757854
  Authorized official Same address or phone

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 (Ament Headache Center)
• Cherry Creek Nutrition
• Cherry Creek Optical
• Cherry Creek Pediatrics, PC
• Cherry Creek Physical Therapy
• Cherry Creek Restorative Dentistry (Cherry Creek Restorative Dentistry PLLC)
• 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.