| NPI | 1134535149 |
|---|---|
| Doing Business As | CHILDREN'S DENTAL CLINIC OF LAS CRUCES |
| Entity Type | Organization |
| Authorized Contact | EBONIE GONZALES Credentialing Manager 505-850-3769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DD3168) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2022-05-17 |