| NPI | 1528169174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KING Owner/President 505-299-7678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM 1752) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |