| NPI | 1063515112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANCE DOUGLAS CARLSON President 303-932-6018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 105272) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-08-22 |