| NPI | 1104377811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HODGES Operations Director 505-787-2965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3385) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2872) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2020-10-15 |