| NPI | 1922247758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERREN ELVIS TIPPETS Owner, Pediatric Dentist 970-240-8694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 9579) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |