| NPI | 1205215506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL E ROUSSEL Owner 505-881-4365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM 1422) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: NM 1422) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2015-06-30 |