Rocky Mountain Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

203 Issued in CO

Legal business name

ROCKY MOUNTAIN ORAL SURGERY

Practice address

1029 Robertson St
Fort Collins, CO 80524-3926

Phone

(970) 493-4434

NPI assigned

Oct 3, 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. Ronald P. Hanawalt, DDA

Title

President

Phone

(970) 493-4434

Specialties & licenses 1

Addresses

Other names 1

• R. P. Hanawalt, DDS Other name

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194819359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 ROBERTSON ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 ROBERTSON ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243926",
            "telephone_number": "970-493-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANAWALT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-493-4434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDA"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "R. P. Hanawalt, DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Fort Collins, CO
• Providers in Fort Collins, 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.