| NPI | 1164891545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JEFFERY POLKE Dentist 303-920-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 7878) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |