| NPI | 1316618119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE KANIFF Owner 970-319-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-22 |