| NPI | 1912167172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY E EVANS Office Manager 970-407-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 7679) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2016-05-25 |