| NPI | 1386053270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURT RADTKE Office Manager 970-673-7321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9157) |
| 1223G0001X Dentist, General Practice (Licence: CO 9442) | |
| 1223G0001X Dentist, General Practice (Licence: CO 202039) | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2014-08-05 |