| NPI | 1669916334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY FAUST COOMBS President 970-226-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WY 1297) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2016-12-14 |