| NPI | 1619357555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER H JOLLEY Doctor/Owner 970-523-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO 9143) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO 10718) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |