| NPI | 1932332285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN A WAGNER Maxillofacial Prosthodontist 505-232-3588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: NM DD1150) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2009-09-02 |