| NPI | 1225601461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY LANCASTER Administrative Assistant 970-945-6614 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2024-04-08 |