| NPI | 1497037402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN JENSEN Orthodontist/Owner 575-522-1779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NM DD3479) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2011-09-15 |