| NPI | 1447384532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDWARD BERWICK President 719-597-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 7202) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |