| NPI | 1003842279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAND L. REDFERN President 719-599-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO HD104066) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CO HD104066) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2020-08-22 |