Organization
WISTERIA DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRANG LE DD (OWNER DENTIST)
(505) 896-6654
Entity
Organization
Contact information
Practice address
1904 WELLSPRING AVE SE, RIO RANCHO, NM 87124-4888
(505) 896-6654
Mailing address
1904 WELLSPRING AVE SE, RIO RANCHO, NM 87124-4888
(505) 896-6654
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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