| NPI | 1952774465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN ANDERSON General Dentist 719-384-9442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 00202659) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2019-02-15 |