| NPI | 1720545007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY BARDIN MOORE Owner/Dentist 719-475-2511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2019-02-22 |