| NPI | 1821262361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY SUZANNE RAICHART CEO 970-926-1519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 7209) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |