| NPI | 1467868596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON RONALD VAN WAGENEN Partner 303-426-4860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8478) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2015-09-16 |