Facts
- Status
- A
- Credential
- D.D.S
- Type
- Individual
- Enumeration date
- 2007-04-25
- Last updated
- 2025-09-02
Specialties
Licenses
- License CO
- 8085
Location
- Practice location
- 1160 W ASH ST
- City
- WINDSOR CO
- Postal code
- 805504666
- Phone
- 970-686-1186
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.