| NPI | 1053901447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANSEN DONOGHUE Member 505-298-6732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |