| NPI | 1609267632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN NYLUND Dentist 575-758-8654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3407) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD1078) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |