| NPI | 1154742377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH A. WILSON Owner 505-325-8858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 8613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 8613) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2013-12-16 |