| NPI | 1558774521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD BURTWISTLE President 719-481-4949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 202045) |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 126800000X Dental Assistant | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2014-06-08 |