| NPI | 1902214406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK R BACA General Dentist 505-876-4034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3492) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |