Fangman & Ivey Oral and Facial Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

FANGMAN & IVEY ORAL AND FACIAL SURGERY PLLC

Doing business as

Altitude Oral and Facial Surgery Center

Practice address

1440 Blake St Ste 100
Denver, CO 80202-1475

Phone

(720) 328-4990

Fax

(720) 328-4994

NPI assigned

Dec 22, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Brian John Fangman, DDS

Title

President/Ceo

Phone

(720) 328-4990

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Altitude Oral and Facial Surgery Center Doing business as

Tax ID family

Altitude Oral and Facial Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fangman & Ivey Oral and Facial Surgery PLLC

  dba Altitude Oral and Facial Surgery Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Denver, CO
  • NPI 1023604535
  NPD tax ID

Locations

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1275120495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 W 44TH AVE STE 100",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802127339",
            "telephone_number": "720-328-4990",
            "fax_number": "720-328-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 BLAKE ST STE 100",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802021475",
            "telephone_number": "720-328-4990",
            "fax_number": "720-328-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANGMAN & IVEY ORAL AND FACIAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "FANGMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "720-328-4990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952791964",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1013358985",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1609027556",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altitude Oral and Facial Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeanette Fanchi
• Jacquelyn Fanciulli
• Kevin Fanciulli, PHARM.D.
• Hsiao-Wei Fang, L.AC.
• Fangman & Ivey Oral and Facial Surgery PLLC (Altitude Oral and Facial Surgery Center)
• Fangman Oral and Facial Surgery Professional LLC (Altitude Oral and Facial Surgery PLLC)
• Fangman Oral and Facial Surgery Professional LLC (Altitude Oral Maxillofacial Implant Center)
• Brian Fangman, DDS
• Gabrielle Danae Fangman, MD
• Timothy Lee Fangmeier, LPC

• 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 Dec 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.