| NPI | 1184087926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER JONES Office Manager 575-523-8663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3511) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM 1270) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2017-04-20 |