| NPI | 1982412904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIA HUY LE Member 505-718-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-02-10 |