| NPI | 1891443073 |
|---|---|
| Doing Business As | MODERN DENTAL AT FLYING HORSE |
| Entity Type | Organization |
| Authorized Contact | GREGORY KOSTELAC Data Analyst 719-372-5605 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2022-03-16 |