| NPI | 1437938479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS DE LEON Assistant Manager 575-208-2380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2023-10-24 |