| NPI | 1104162452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WALTER JOHNSON President 970-385-5432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO c36335) |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2012-12-13 |