| NPI | 1730256033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M SHADDOCK Dentist 970-356-2605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 430) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |