| NPI | 1417246562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH A WILSON Owner 702-469-3590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NM DD3399) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2011-03-29 |