| NPI | 1477959013 |
|---|---|
| Doing Business As | ROUTE 66 CHILDREN'S DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | EBONIE GONZALES Credentialing Manager 505-850-3769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2022-05-23 |