| NPI | 1417186867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA LURCOTT Authorized Official 303-744-1369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2021-08-27 |