| NPI | 1518561364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA RENEHAN Administrator 719-540-6350 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |