| NPI | 1124521125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY F COOMBS Sole Shareholder 970-226-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1297) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2018-05-07 |