| NPI | 1073746319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY EUGENE GOINGS Owner 970-377-1888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2009-09-03 |