| NPI | 1790270080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLE R KEYSER Office Receptionist 719-439-3228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 9700) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2018-06-28 |