| NPI | 1881103026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE OLSON Regional Human Resource Director 719-344-5693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CO 202298) |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2022-07-21 |