Organization
ELIZABETH M. WILSON DMD LLC
Active
Parent organization
-
Organization subpart
Yes
Provider details
NPI number
Legal business name
-
Authorized official
ELIZABETH WILSON DMD (OWNER/DENTIST)
(505) 988-4333
Entity
Organization
Contact information
Practice address
217 E MARCY ST, SANTA FE, NM 87501-2020
(505) 988-4333
Mailing address
217 E MARCY ST, SANTA FE, NM 87501-2020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3170
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17334829
—
NM
Enumeration date
11/29/2012
Last updated
11/29/2012
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