| NPI | 1578721106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BANGORN S TERRY Owner 719-227-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-05-30 |