| NPI | 1730424904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH WILSON Owner/Dentist 505-988-4333 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3170) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2012-11-29 |