| NPI | 1750622072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH A WILSON Owner 505-325-8858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3399) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NM DD3399) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2013-03-12 |