| NPI | 1437550050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY OLSON Practice Manager 970-351-6166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 8350) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |