| NPI | 1194200717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGDALENA EVANS Sr Credentialing Specialist 720-603-4763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2024-10-14 |