| NPI | 1942644844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY REDMOND Manager 303-216-1108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2016-11-14 |