| NPI | 1811238264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL J RUSSELL Owner 720-870-1451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: CO DEN.00201913) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2013-03-11 |