| NPI | 1982913935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH CHILDRESS President 719-671-7369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 2704) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2012-03-14 |