| NPI | 1346833571 |
|---|---|
| Former Legal Business Name | WOODMOOR DENTAL |
| Entity Type | Organization |
| Authorized Contact | ANDREW WILSON DETHLOFF Owner/Dentist 719-488-3014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-02-18 |