| NPI | 1164725503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE BROWN Manager 505-326-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD2287) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD2872) |
| 122300000X Dentist (Licence: NM DD3016) | |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2014-06-17 |