| NPI | 1356709661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SILL Owner 505-883-5835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 1484) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3266) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2023-05-22 |