| NPI | 1952810715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA HENDRICKS General Manager 505-603-6220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NM 4731) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |