Oral Surgery Specialists of Pueblo, PLLC

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

Legal business name

ORAL SURGERY SPECIALISTS OF PUEBLO, PLLC

Practice address

3691 Parker Blvd
Pueblo, CO 81008-2278

Phone

(719) 212-0777

NPI assigned

May 25, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Tyler E Nelson, DDS

Title

Owner

Phone

(719) 597-4060

Specialties & licenses 1

Addresses

Other names 1

• ORAL SURGERY SPECIALISTS OF PUEBLO Doing business as

Locations

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

{
    "created_epoch": "1495670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495670400000",
    "number": "1619405396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 N ACADEMY BLVD STE 213",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175332",
            "telephone_number": "719-597-4060",
            "fax_number": "719-574-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3691 PARKER BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082278",
            "telephone_number": "719-212-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL SURGERY SPECIALISTS OF PUEBLO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-25",
        "last_updated": "2017-05-25",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-597-4060",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORAL SURGERY SPECIALISTS OF PUEBLO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2017; 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.