| NPI | 1285406728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZ BLEVINS Office Mangager 719-622-1225 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2023-10-27 |