| NPI | 1679037675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA SALAZAR Billing 505-592-0482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2019-02-04 |