| NPI | 1124512488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MONTANO Dentist/Owner 505-888-3112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NM DD3304) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |