| NPI | 1013362276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JAMES INGERSOLL President 970-686-1186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CO 201837) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2016-04-25 |