| NPI | 1790988830 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | EDWARD J LACY Dentist President 970-667-2372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 5899) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-08-22 |