| NPI | 1063890440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA COLLETTE HOLLING Practice Administrator 970-669-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 8614) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2015-05-18 |