| NPI | 1720117062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA R FUDZINSKI Chief Executive Officer 505-299-6112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM dh1036) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2020-08-22 |