| NPI | 1548486079 |
|---|---|
| Other Name | SOUTHWEST DENTAL |
| Entity Type | Organization |
| Authorized Contact | JEFFREY RAY MATTILA President 505-287-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD1754) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |