| NPI | 1295179554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH R. FUNDERBURK Owner/Doctor 970-241-2820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO 10676) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2021-10-21 |