| NPI | 1356701072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES N THEOBALD Owner/Presedent 303-791-0413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00291) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |