| NPI | 1174167217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL GIMENEZ Credentialing Senior Manager 719-300-5933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2026-03-27 |