| NPI | 1457774168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ENA MARIE MILLICH Owner 970-563-0373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: CO 2023390) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2020-07-17 |