| NPI | 1811310709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED S. GIOMBOLINI Owner 505-883-5835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 1484) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |