| NPI | 1912060450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE A CLINE Practice Administrator 303-321-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-06-10 |