| NPI | 1669038105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM SCHLEPPY Director Payor Relations 970-224-4294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-05-09 |