| NPI | 1932957909 |
|---|---|
| Doing Business As | COTTAGE LAKE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | NICK SUNDIAM Credentialing Manager 719-300-5933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-05-07 |