| NPI | 1265860936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARISSA J GREINEL-BLUM Owner 505-821-1430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM dd3005) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM dd2155) |
| 1223G0001X Dentist, General Practice (Licence: NM dd3003) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2013-10-16 |