JUST WISDOM TEETH FREDERICK, LLC (NPI# 1497265516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497265516 |
| Entity Type | Organization |
| Organization Name | JUST WISDOM TEETH FREDERICK, LLC |
| Practice Address |
4943 Highway 52 260 Frederick CO 80514 |
| Mailing Address |
1791 Kerr Gulch Rd Evergreen CO 80439-6397 |
| Practice Telephone | 7209905544 |
| Mailing Telephone | 7204701091 |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2020-04-24 |
| Authorized Official Name | NINO POLLACCIA (OWNER) |
| Authorized Official Telephone | 7209905544 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10160 W 50th Ave Unit 1, Wheat Ridge, CO 800332339 | 7205830523 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Just Wisdom Teeth Frederick, LLC | 4943 Highway 52, Suite 260, Frederick, CO 80514 |
| Street Address |
4943 HIGHWAY 52 260 |
| City | FREDERICK |
| State | CO |
| Zip Code | 80514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437573573 | Froc, PC | Orthopaedic Surgery | 4943 Highway 52, Suite 100, Frederick, CO 80514 | 2014-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861024101 | Catholic Health Initiatives Colorado | Clinic/Center | 4943 Hwy 52, Frederick, CO 80514 | 2020-02-05 |
| 1730324773 | Christy Maurine Griffin | Social Worker | 536 Colorado Boulevard, Dacono, CO 80514 | 2008-12-04 |
| 1023012366 | Bruce W Martin | Family Medicine | 3101 Summit View Dr., Dacono, CO 80514 | 2005-06-01 |
| 1497164602 | Catholic Health Initiatives Colorado | Family Medicine | 3101 Summit View Dr, Dacono, CO 80514-8200 | 2014-08-13 |
| 1699184812 | Catholic Health Initiatives Colorado | Obstetrics & Gynecology | 3101 Summit View Dr, Dacono, CO 80514-8200 | 2014-08-13 |
| 1205240165 | Haven Patterson | Occupational Therapy Assistant | 3080 Meadowbrook Pl, Dacono, CO 80514-8523 | 2014-06-18 |
| 1568467983 | Clint Flanagan | Family Medicine | 4943 State Highway 52, Ste 240, Dacono, CO 80514-9100 | 2005-06-14 |
| 1619368545 | Janine Leki | Marriage & Family Therapist | 4943 State Highway 52, Dacono, CO 80514-9100 | 2015-02-13 |
| 1427290949 | Carrie Elizabeth Wilcox | Family Medicine | 4943 State Highway 52, Ste 240, Dacono, CO 80514-9100 | 2009-03-30 |
| 1437116555 | Charles E Tawa | Family Medicine | 4943 State Highway 52, Dacono, CO 80514-9100 | 2006-05-01 |
| Find all providers in zip 80514 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639141609 | Peter M Tan | Oral & Maxillofacial Surgery | 68 Thomas Johnson Dr, Suite A, Frederick, MD 21702 | 2006-02-03 |
| 1871564567 | Ronald C Best | Oral & Maxillofacial Surgery | 68 Thomas Johnson Dr, Ste A, Frederick, MD 21702 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588271126 | Saddle Rock Oral and Facial Reconstructive Surgery Pllc | Oral & Maxillofacial Surgery | 7380 S. Gartrell Rd, Aurora, CO 80016 | 2020-09-28 |
| 1689916611 | Ben Adam Charles Bailey | Oral & Maxillofacial Surgery | 3691 Parker Blvd Ste 200, Pueblo, CO 81008-2278 | 2013-03-16 |
| 1952677973 | Colorado Surgical Arts | Oral & Maxillofacial Surgery | 2900 S. Peoria Street, Unit D, Aurora, CO 80014 | 2012-03-23 |
| 1275831208 | Kamran Dastoury | Oral & Maxillofacial Surgery | 2290 Kipling St Unit 2, Lakewood, CO 80215-1546 | 2011-02-28 |
| 1215190145 | Michael S Kunkel | Oral & Maxillofacial Surgery | 3475 Briargate Blvd, Suite 102, Colorado Springs, CO 80920 | 2008-07-10 |
| 1740494467 | Norman Philip Payea II | Oral & Maxillofacial Surgery | 8805 West Fourteenth Avenue, Suite 316 Lakewood Medical Center, Lakewood, CO 80215-4848 | 2007-05-10 |
| 1902931835 | Steven F. Reck, Dds, PC | Oral & Maxillofacial Surgery | 1201 Paseo Del Norte, Pueblo, CO 81008-2611 | 2007-02-22 |
| 1548342629 | Barry S Keogh | Oral & Maxillofacial Surgery | 14991 E Hampden Ave #260, Aurora, CO 80014 | 2006-10-19 |
| 1033204094 | Michael Derrick Moody | Oral & Maxillofacial Surgery | 9990 W 26th Ave, Suite 100, Lakewood, CO 80215-1581 | 2006-10-04 |
| 1629085196 | Glenn Eric Herrmann | Oral & Maxillofacial Surgery | 130 Old Laramie Trl E Bldg 4, Lafayette, CO 80026-7014 | 2006-08-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.