| NPI | 1336860584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY JORGENSEN Partner 505-891-9440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |