| NPI | 1053552646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN URBANOZO Credentialing Manager 719-323-2362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2020-11-19 |