| NPI | 1881149300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BREANNE MARTINEZ Office Manager 719-596-3481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10399) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2022-03-04 |