| NPI | 1881747319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA ANNE NICHOLSON Office Manager 303-703-4544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 6372) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 6619) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-08-22 |