| NPI | 1184968992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANN JODY MCCAULEY Owner 575-236-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NM DH1521) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2012-11-16 |