| NPI | 1881011864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY B WHEATON Owner 505-992-1550 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM 2052) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-27 |