| NPI | 1255660080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN GEORGE WILSON Owner 970-249-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 8632) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2009-12-07 |