NPIMap

Organization Active NPI

Fangman Oral and Facial Surgery Professional LLC

Doing business as Altitude Oral & Facial Surgery PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Windsor, CO
National Provider Identifier
1750038089
Registry record updated Apr 11, 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
Doing business as
Altitude Oral & Facial Surgery PLLC
Practice address
1555 Main St Unit A2
Windsor, CO 80550-5999
Phone
(720) 328-4990
Fax
(720) 328-4994
NPI assigned
Mar 7, 2022
Last updated
Apr 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Dr. Brian J FangmanNPI 1609027556
Title
DDS
Phone
(614) 354-7468

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1555 Main St Unit A2
Windsor, CO 80550-5999

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1609027556OtherNYINDIVIDUAL NPI
82781257MedicaidCO

Other names 1

  • Altitude Oral & 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.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1750038089",
    "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": "1555 MAIN ST UNIT A2",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805505999",
            "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": "2022-03-07",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "FANGMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "614-354-7468",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1609027556",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82781257",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altitude Oral & Facial Surgery PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windsor, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.