| NPI | 1376989343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE K. ARBUCKLE Credentialing Specialist 303-285-6098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 6097) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO 10541) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2016-05-17 |