Organization
PORTALES DENTAL ARTS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BUCK R WILSON D.D.S. (PRESIDENT)
(505) 356-8514
Entity
Organization
Contact information
Practice address
1521 W 18TH ST, PORTALES, NM 88130-7018
(505) 356-8514
Mailing address
1521 W 18TH ST, PORTALES, NM 88130-7018
(505) 356-8514
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD916
NM
Other
Enumeration date
05/18/2007
Last updated
08/22/2020
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