| NPI | 1710137773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE RAYE FULLER Co Owner 505-553-6850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NM dh986) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NM dh1235) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2008-09-26 |