| NPI | 1003058116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL PACKER Owner/President 303-286-4382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 8499) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 8466) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 105855) | |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2009-04-03 |