| NPI | 1881119220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBIE WILSON Office Manager 719-494-2865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00009216) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202336) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-07-21 |