| NPI | 1891022505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY A COOK Manager 719-574-8922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9312) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10001) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2017-08-09 |