| NPI | 1629662770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA MULKAY Insurance Credentialing 970-928-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-01 |