| NPI | 1114337136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIKKI BIERNACKI Practice Manager 719-592-9222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 6709) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2014-04-29 |