| NPI | 1487190393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLTON FLAKE Owner 720-277-5930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO 10630) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10630) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |