| NPI | 1942477153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWAYNE LEE GLENN Owner/Dentist 303-779-2592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 3462) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9518) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2008-05-15 |