| NPI | 1497727747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREL LYNN DEANDA Practice Administrator 505-884-9793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM NM1559) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-10-21 |