| NPI | 1417486481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LELAND BLANE KIMBALL President 970-232-3750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 202034) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2017-06-05 |