| NPI | 1033045679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE CONSTUBLE Business Manager 719-564-6464 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-06-22 |
| Last Update Date | 2026-06-22 |