| NPI | 1972109957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUBIE TAFOYA-QUEZADA Senior Office Administrator 303-655-8228 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |