| NPI | 1790993376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON C PAYNE President 719-542-4546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 10136) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-11-10 |