| NPI | 1104030121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DUANE FOWLER President 303-771-6969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 7725) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2020-08-22 |