| NPI | 1740452697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNIE C YAZZIE Chief Executive Officer 505-722-1403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: 9435) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-07-22 |