| NPI | 1043642747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY PERRY THERIOT Owner 303-758-4287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 105385) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CO 6671) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |