| NPI | 1780938274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA JACKSTIEN Owner/Partner 720-606-4220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO 00201856) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2022-07-21 |