| NPI | 1700241890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS TRENT SHEPHERD President 505-787-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4720) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |