| NPI | 1558709691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUD MAHLON FRALEIGH Owner 505-293-2644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NM DD2619) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |