| NPI | 1962502120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN ROYDEN DEAN President 970-241-1313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 104423) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 1356539922) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |