| NPI | 1619260502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA A DAVIS Office Manager 505-877-0435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2011-05-25 |