| NPI | 1013603216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY GOGGANS President 719-569-5715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |