| NPI | 1962743534 |
|---|---|
| Doing Business As | GUADALUPE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | LISA WALRAVEN CEO 575-355-2420 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2018-02-01 |