| NPI | 1093867905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM G. SHANER President 1719-599-5107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 285) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |