| NPI | 1528593001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA L CASTILLO Manager 505-554-2262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3595) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4343) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |