| NPI | 1356558845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY G BOURDON Owner Dentist 719-542-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 105821) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-08-22 |