| NPI | 1376663641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDAL L BEAR-DAVEY Administrator 719-473-2650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |