| NPI | 1275738668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLUS GLADNEY President 505-876-1065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NM DD1966) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-08-22 |