| NPI | 1285091181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONIE MARIE BOGDAN Credentialing Specialist 505-892-9010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD4435) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-01-22 |