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 |