| NPI | 1770732208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET MICHAEL GREEN Dr. 505-299-9606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD2141) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD2322) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2008-09-09 |