| NPI | 1497787535 |
|---|---|
| Doing Business As | DENTAL |
| Entity Type | Organization |
| Authorized Contact | RYAN SPILLANE Chief Financial Office 719-344-7135 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-08-08 |