| NPI | 1871902593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HODGES Operations Director 505-787-2965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD2287) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-10-15 |