| NPI | 1871777136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY LEON ROBERTS Managing Member 719-542-6014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 105202) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2012-08-09 |