| NPI | 1043373004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE E WAGGONER President 303-777-1603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 7506) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-22 |