| NPI | 1891973533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN URBANOZO Credentialing Manager 719-323-2362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 51044) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2024-08-26 |