| NPI | 1295403186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN POOVEY Dds 970-243-2026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 292200000X Dental Laboratory |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2021-09-09 |