| NPI | 1205052842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARL LACKLER Periodontist 719-574-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 8251) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CO 7405) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |