| NPI | 1063493427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JAMES GOODIS Owner 505-797-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NM DD1868) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: NM DD1759) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2020-08-22 |