Rocky Mountain Oral & Maxillofacial Surgery, Prof LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ROCKY MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PROF LLC

Practice address

10375 Park Meadows Dr Ste 150
Lone Tree, CO 80124-6755

Phone

(720) 452-2144

Fax

(303) 379-9051

NPI assigned

Sep 13, 2023

Last updated

Sep 13, 2023By 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

Michael Rollert, DDSNPI 1255396768

Title

Dentist/Owner

Phone

(303) 503-5039

Specialties & licenses 1

Addresses

Tax ID family

Rocky Mountain Oral Maxillofacial Surgery Prof 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.

• Rocky Mountain Oral & Maxillofacial Surgery, Prof LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Thornton, CO
  • NPI 1366126583
  NPD tax ID

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.

• Michael K Rollert, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Thornton, CO
  • NPI 1255396768
  NPD Authorized official

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1518744416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 E 136TH AVE STE 101",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802413530",
            "telephone_number": "720-452-2144",
            "fax_number": "303-379-9051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10375 PARK MEADOWS DR STE 150",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801246755",
            "telephone_number": "720-452-2144",
            "fax_number": "303-379-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PROF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "ROLLERT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "303-503-5039",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Lone Tree, CO
• Providers in Lone Tree, 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 Sep 13, 2023; 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.