| NPI | 1801536727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT CORY RYAN Owner 303-501-2212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2024-11-04 |