NPI 1629290283

Wildwind Dental

Organisation Dentist Los Alamos, NM

Practice location

Address: 111 Longview Drive Suite B3, Los Alamos, NM 87544
Phone: (505) 672-2020
Fax: (505) 672-2020
Mailing address: 203 Rio Bravo, Los Alamos, NM 87544

Authorised official

Name: Ellen Vandergust Ballard
Title: President Wildwind Dental
Phone: (505) 672-2020

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 1668 (NM)

Other Dentist providers in New Mexico →

Registry record

NPI: 1629290283
Entity type: Organization
NPI issued: 3 May 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.