Individual
NATHAN VAITAUTOLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1667 COCHRANE CIR BLDG 7495, FORT CARSON, CO 80913-4603
(719) 526-5537
Mailing address
1667 COCHRANE CIR BLDG 7495, FORT CARSON, CO 80913-4603
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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