| NPI | 1558736991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY M KELLY Owner/Dentist 505-256-1770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: NM 1413) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NM 1413) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2021-02-19 |