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Organization
JUAN TABO DENTISTRY LLC
Active
Organization
JUAN TABO DENTISTRY LLC
Active
Other names
Delicate Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
1924 JUAN TABO BLVD NE STE C, ALBUQUERQUE, NM 87112-3358
(505) 293-3451
Mailing address
1924 JUAN TABO BLVD NE STE C, ALBUQUERQUE, NM 87112-3358
(505) 293-3451
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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