| NPI | 1336570167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE VACHA Executive Director 719-338-2195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: CO 8109) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CO 903783) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2013-12-04 |