Nirvana LLC

NPI #1710137773 in Corrales, New Mexico

Provider Information

NPI Number: 1710137773
Entity Type: Organization
Organization Name: Nirvana LLC
Primary Specialty: Dental Hygienist
Enumeration Date: Sep 26, 2008
Last Updated: Sep 26, 2008

Practice Location

Address: 161 RAILCAR RD
City: Corrales
State: New Mexico
ZIP Code: 87048-7909
Phone: (505) 553-6850

Authorized Official

Name: MS. JULIE RAYE FULLER, RDH
Title: CO-OWNER
Phone: (505) 553-6850

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Hygienist	124Q00000X	Primary

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