| NPI | 1053521211 |
|---|---|
| Former Legal Business Name | COUNTY LINE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | RICHARD E GREEN Owner 303-770-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 105403) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2013-08-07 |