| NPI | 1538488317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MAKI Dentist 307-742-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WY 1243) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CO 9642) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2012-12-11 |