| NPI | 1821477027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE MARIE PRENDERGAST Sole Mbr 720-457-1110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-10-07 |