| NPI | 1992422653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT RYAN Owner 303-422-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2026-08-25 |