| NPI | 1538531173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID TERVEEN Owner 719-634-4805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2024-07-29 |