| NPI | 1427320654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HODGES Operations Director 505-787-2965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM CS00213848) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2020-10-15 |