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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