| NPI | 1629457635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JOHN WACHUTA Dentist/Owner 303-638-9440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: CO 7007) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CO 7007) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |