| NPI | 1003250416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON EHTESSABIAN Owner/Dentist 719-342-3806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9520) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2016-02-17 |