| NPI | 1487211124 |
|---|---|
| Doing Business As | A WILD SMILE |
| Entity Type | Organization |
| Authorized Contact | DEBBIE FITZGERALD Practice Manager 720-945-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |