| NPI | 1598936163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY W RENEHAN President 719-540-6350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8508) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2008-03-21 |