| NPI | 1295037646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLAS ROGER PRUETT Owner/Dentist 719-576-5566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8913) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9966) |
| 1223G0001X Dentist, General Practice (Licence: CO 9952) | |
| 124Q00000X Dental Hygienist (Licence: CO 905802) | |
| 124Q00000X Dental Hygienist (Licence: CO 905995) | |
| 124Q00000X Dental Hygienist (Licence: CO 906138) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2010-11-17 |