| NPI | 1154657294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LEA SMITH Regional Director 720-371-2309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CO 9379) |
| Enumeration Date | 2009-10-24 |
| Last Update Date | 2009-10-24 |