| NPI | 1265529655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL H MORTAJI Dentist 505-839-3703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |