| NPI | 1558666883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE A O'QUINN Owner 575-742-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD1887) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3395) |
| 124Q00000X Dental Hygienist (Licence: NM DH1504) | |
| 124Q00000X Dental Hygienist (Licence: NM DH2245) | |
| 124Q00000X Dental Hygienist (Licence: NM DH2884) | |
| 126800000X Dental Assistant (Licence: NM DA3975) | |
| 126800000X Dental Assistant (Licence: NM DA2349) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2019-12-23 |