Wisteria Dental LLC
NPI #1306650833 in Rio Rancho, New Mexico
Provider Information
- NPI Number
- 1306650833
- Entity Type
- Organization
- Organization Name
- Wisteria Dental LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Feb 5, 2025
- Last Updated
- Feb 5, 2025
Practice Location
- Address
- 1904 WELLSPRING AVE SE
- City
- Rio Rancho
- State
- New Mexico
- ZIP Code
- 87124-4888
- Phone
- (505) 896-6654
Authorized Official
- Name
- TRANG LE, DD
- Title
- OWNER DENTIST
- Phone
- (505) 896-6654
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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