Individual
DR. KIRK SCOTT WONDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4320 RIDGECREST DR SE STE E, RIO RANCHO, NM 87124-5971
(505) 891-1100
(505) 891-1094
Mailing address
4320 RIDGECREST DR SE STE E, RIO RANCHO, NM 87124-5971
(505) 891-1100
(505) 891-1094
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1796
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
817303
UNITED CONCORDIA
NM
Enumeration date
07/09/2006
Last updated
07/08/2007
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