| NPI | 1326775800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MESA ROTH Partner 970-484-5297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223X2210X Dentist Orofacial Pain |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2022-08-04 |