| NPI | 1184157315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE A HARRIS President 575-751-9661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD1953) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NM DD3454) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD1576) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD4507) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2017-05-04 |