NPIMap

Organization Active NPI

Fangman Oral and Facial Surgery Professional LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Commerce City, CO
National Provider Identifier
1386398667
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
FANGMAN ORAL AND FACIAL SURGERY PROFESSIONAL LLC
Practice address
18335 E 103Rd Ave Unit 102
Commerce City, CO 80022-3103
Phone
(720) 328-4990
Fax
(720) 328-4994
NPI assigned
Feb 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Authorized official

Name
Brian Fangman, DDS
Title
Owner/Oral Surgeron
Phone
(720) 328-4990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X Primary

Addresses

Primary practice location

18335 E 103Rd Ave Unit 102
Commerce City, CO 80022-3103

Mailing address

5600 W 44TH Ave # 100
Denver, CO 80212-7339
Phone (720) 328-4990

Other identifiers 2

IdentifierTypeStateIssuer
1952791964MedicaidCO
1609027556OtherNYNPI

Other names 1

  • Altitude Oral and Facial Surgery PLLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fangman Oral and Facial Surgery Professional LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

18335 E 103rd Ave
Unit 102
Commerce City, CO 80022
Phone (720) 328-4990

5600 W 44th Ave
#100
Denver, CO 80212

NPI Registry JSON

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1386398667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 W 44TH AVE # 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": "18335 E 103RD AVE UNIT 102",
            "city": "COMMERCE CITY",
            "state": "CO",
            "postal_code": "800223103",
            "telephone_number": "720-328-4990",
            "fax_number": "720-328-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANGMAN ORAL AND FACIAL SURGERY PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "FANGMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/ORAL SURGERON",
        "authorized_official_telephone_number": "720-328-4990",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, 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": "NPI",
            "identifier": "1609027556",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altitude Oral and Facial Surgery PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Commerce City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.