| NPI | 1679507859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS D. PARKS President 505-334-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD 1903) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-08-22 |