| NPI | 1235386459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAX WAGNER Partner 505-266-5881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NM DD788) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |