| NPI | 1306380084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL S TORNOW Dentist Owner 505-947-4253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5015649-9923) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2016-12-14 |