| NPI | 1427483486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAKE MINNICH Clinical COO Rdinator 719-576-6551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 9877) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |