Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DEN.00203636 | CO |
NPI | 1043881790 |
---|---|
Provider Name | Matthew Iritani |
First Address | Greenwood Village, CO 80111-2890 |
Second Address | Greenwood Village, CO 80111-2890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2021 |
Last Update Date | 04/07/2021 |