| NPI | 1730434622 |
|---|---|
| Doing Business As | FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | CHARLES RODGERS Dds/ Owner 719-382-4936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9356) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2012-07-17 |