| NPI | 1104124080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM GREGORY ROSE Business Owner 505-296-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD1897) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2011-04-26 |