| NPI | 1558590596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L. CHILDRESS Office Mgr. 719-546-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CO 3009) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2016-08-30 |