| NPI | 1629731435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILIAN JAIME Owner 505-379-4810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-11-15 |