Wildwind Dental

NPI #1629290283 in Los Alamos, New Mexico

Provider Information

NPI Number: 1629290283
Entity Type: Organization
Organization Name: Wildwind Dental
Primary Specialty: Dentist
Enumeration Date: May 3, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 111 LONGVIEW DRIVE
Address 2: SUITE B3
City: Los Alamos
State: New Mexico
ZIP Code: 87544
Phone: (505) 672-2020

Authorized Official

Name: DR. ELLEN VANDERGUST BALLARD, DDS
Title: PRESIDENT WILDWIND DENTAL
Phone: (505) 672-2020

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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