| NPI | 1093043002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN E. JENSEN Owner/Dentist 505-982-4317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 3139) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2010-02-04 |