| NPI | 1003689431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONIE GONZALES Credentialing 505-850-3769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2023-11-07 |