| NPI | 1104228329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY K BRADFORD Office Manager 505-333-8635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2021-03-03 |