| NPI | 1104371012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAYNA BAHR Manager 303-524-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2008019818) |
| Enumeration Date | 2016-08-20 |
| Last Update Date | 2016-08-24 |