# CDB 550 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DBA Celebrate Dental and Braces
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174992564
- **Authorized official:** DR. JONAH L FOUTZ DD3662 (OWNER)
- **Authorized official phone:** (505) 550-0305

## Contact information

- **Practice address:** 120 E HIGHWAY 550, BERNALILLO, NM 87004-5967
- **Practice address phone:** (505) 550-0503
- **Mailing address:** 120 E HIGHWAY 550, BERNALILLO, NM 87004-5967

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD3662 | NM | Yes |

## Other

- **Enumeration date:** 09/16/2015
- **Last updated:** 09/16/2015