| NPI | 1326321282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHETT MARVIN QUIST Owner 719-359-8652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8040) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2011-09-27 |