| NPI | 1891225348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA KATHERINE OSTROM Credentialing/Billing 719-597-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-07-21 |