| NPI | 1154264844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONIE GONZALES Credentialing Specialist 505-850-3769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2026-04-09 |
| Last Update Date | 2026-04-09 |