| NPI | 1295823177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE SUAZO Owner 505-599-9359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM D1997) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD1997) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-11-26 |