| NPI | 1972081941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHNSON Managing Member 720-201-5801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: SC 8911) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2019-12-10 |