| NPI | 1417501180 |
|---|---|
| Doing Business As | STANDLEY LAKE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | GREGORY KOSTELAC Credentialing Specialist 719-372-5605 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2021-07-23 |