| NPI | 1003221854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIANNE HAZELTON ISHAM Practice Manager 719-528-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 6088) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-06-30 |