| NPI | 1144745647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY WILSON Dr. 719-846-7387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CO 7109) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-07-21 |