| NPI | 1043480452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE WAYNE HALTOM Owner 970-945-9644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CO Hd104468) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2008-03-03 |