| NPI | 1609249804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN G WILSON Owner/Dentist 970-901-9865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 2010033385) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2015-11-10 |