| NPI | 1538690573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON S BERGUIN President 970-241-3483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO CO105656) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO CO201868) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-03-22 |