| NPI | 1518216746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMERA PAGE COFFMAN Owner Dentist 505-433-3366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD3279) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2012-09-04 |