| NPI | 1376989707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KUNKEL Managing Member 719-264-6070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO DEN.00201943) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2013-05-13 |