| NPI | 1124372156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA PRESTON FOWLER President/Owner 970-667-8782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CO 10414) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-10-29 |