# SUNDANCE DENTAL CARE OF GRANTS

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

## Provider details

- **NPI number:** 1467818518
- **Authorized official:** MR. MICHAEL D KING DMD (OWNER)
- **Authorized official phone:** (505) 722-4422

## Contact information

- **Practice address:** 920 LOBO CANYON RD, GRANTS, NM 87020-2173
- **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 | 2966 | NM | Yes |

## Other

- **Enumeration date:** 01/05/2016
- **Last updated:** 01/05/2016

## Other identifiers

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