| NPI | 1891749040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE EUGENE MIODUSKI Dentist 970-663-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO CO105715) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO CO8285) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-05-17 |