| NPI | 1275187064 |
|---|---|
| Doing Business As | COLORADO DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | MICHELLE JOHNSON Credentialing Specialist 509-315-8338 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2019-07-30 |