| NPI | 1225588221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J WILLOUGHBY Sole Owner 303-320-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO 40115) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2016-10-13 |