| NPI | 1083117493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WISE Dentist 303-204-4852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist (Licence: CO CO809) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2018-03-12 |