| NPI | 1821405069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG JANKE Office Manager 505-994-9693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD2780) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |