| NPI | 1245212323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MASON MINER Dentist/Owner 970-247-2677 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 8689) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2019-10-02 |