| NPI | 1124571617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI CACKOVIC Owner 303-952-9796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO DH.000906409) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2022-07-21 |