| NPI | 1326149915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL WAYNE NORTHUP Co Owner 970-242-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 7116) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CO 7175) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |