| NPI | 1922752195 |
|---|---|
| Doing Business As | MY PEDIATRIC DENTIST LONGMONT |
| Entity Type | Organization |
| Authorized Contact | DERREN TIPPETS Owner 970-901-1889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-07 |