| NPI | 1902920705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R. KELLY PETERSEN President 720-851-7069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7978) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |