| NPI | 1588931042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD MICHAEL PARCO Owner 719-671-5617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25762) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25762) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |