| NPI | 1770696064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY GIBSON Office Mgr 505-293-6125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 1350) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM 1844) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-08-22 |