| NPI | 1609250810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLOR CLARK Owner 970-247-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO 201890) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |