| NPI | 1477293496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT RYAN Owner 303-501-2212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-08-11 |