| NPI | 1275915142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE BRYAN MASTIN Owner 719-633-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 7300) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2015-06-26 |