| NPI | 1023616034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN STEGMAN Credentialing Co Ordinator 719-599-0500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-10-12 |