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Organization
DENTAL STUDIO ON 30TH STREET PC
Active
Organization
DENTAL STUDIO ON 30TH STREET PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH WILSON DMD, MSD, LLC (OWNER)
(505) 360-9592
Entity
Organization
Contact information
Practice address
2401 E 30TH ST, FARMINGTON, NM 87401-8939
(505) 325-8858
Mailing address
2401 E 30TH ST, FARMINGTON, NM 87401-8939
(505) 325-8858
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3399
NM
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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