| NPI | 1578969754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH A WILSON Owner 505-360-9592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD3399) |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2014-11-14 |