Provider Demographics
NPI:1174768998
Name:MONUMENT ORAL AND FACIAL SURGERY, PC
Entity type:Organization
Organization Name:MONUMENT ORAL AND FACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-424-5014
Mailing Address - Street 1:607 25 RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1287
Mailing Address - Country:US
Mailing Address - Phone:970-424-5014
Mailing Address - Fax:970-424-5062
Practice Address - Street 1:607 25 RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1287
Practice Address - Country:US
Practice Address - Phone:970-424-5014
Practice Address - Fax:970-424-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty