| NPI | 1740543933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN WILLOUGHBY Sole Owner 303-320-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| 204E00000X Oral & Maxillofacial Surgery | |
| 208200000X Plastic Surgery | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2023-03-07 |