| NPI | 1023377363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA LEVI ELLISS Owner 575-522-0454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3482) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2012-05-07 |