| NPI | 1689616088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE SUE HOLT Practice Administrator 970-245-0785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 104205) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-08-22 |