| NPI | 1821299702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN URBANOZO Credentialing Manager 719-323-2362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO 7992) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-11-23 |