NPIMap

Organization Active NPI

Squire Oral, Facial & Dental Implant Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Longmont, CO
National Provider Identifier
1396020657
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
8762 Issued in CO
Legal business name
SQUIRE ORAL, FACIAL & DENTAL IMPLANT SURGERY
Practice address
1361 Francis St. Ste. 101
Longmont, CO 80501
Phone
(303) 772-8585
NPI assigned
Oct 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Authorized official

Name
Sherry K Matz
Title
Dental Facilitator
Phone
(303) 772-8585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 8762 CO Primary

Addresses

Primary practice location

1361 Francis St. Ste. 101
Longmont, CO 80501

Mailing address

1325 Hover St. Ste. 101
Longmont, CO 80501
Phone (303) 772-8585

National Provider Directory

National Provider Directory
Tax ID family
Oral and Maxillofacial Surgery of Longmont LLC2 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.

Locations

1325 Hover St
Ste 101
Longmont, CO 80501
Phone (303) 772-8585

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1396020657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 HOVER ST. STE. 101",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "80501",
            "telephone_number": "303-772-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 FRANCIS ST. STE. 101",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "80501",
            "telephone_number": "303-772-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUIRE ORAL, FACIAL & DENTAL IMPLANT SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "MATZ",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DENTAL FACILITATOR",
        "authorized_official_telephone_number": "303-772-8585"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "8762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.