| NPI | 1649631359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN G ZASTROW Member/Owner 970-766-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8154) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 464) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |