| NPI | 1164228318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL GIMENEZ Credentialing Manager 719-300-5933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| 1223E0200X Dentist, Endodontics | |
| 1223G0001X Dentist, General Practice | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 122400000X Denturist | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-02-27 |