| NPI | 1235216052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JOHNSON Practice Manager 719-597-9737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 536) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |