# SUNDANCE DENTAL CARE OF GALLUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235406927
- **Authorized official:** DR. BRUCE B SHAHEEN DDS (DENTIST/OWNER)
- **Authorized official phone:** (505) 722-4422

## Contact information

- **Practice address:** 1601 S SECOND ST, GALLUP, NM 87301-5816
- **Practice address phone:** (505) 722-4422
- **Practice address fax:** (505) 722-2060
- **Mailing address:** 1601 S SECOND ST, GALLUP, NM 87301-5816
- **Mailing address phone:** (505) 722-4422
- **Mailing address fax:** (505) 722-2060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD3503 | NM | Yes |

## Other

- **Enumeration date:** 11/23/2011
- **Last updated:** 12/14/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 97524239 | — | NM |