| NPI | 1962770446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN C THORNAL Dentist 970-947-1273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9296) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 8849) |
| 122300000X Dentist (Licence: CO 9089) | |
| 122300000X Dentist (Licence: CO 10199) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |