# JUAN TABO DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Delicate Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477197804
- **Authorized official:** FAITH GASKINS (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 1924 JUAN TABO BLVD NE STE C, ALBUQUERQUE, NM 87112-3358
- **Practice address phone:** (505) 293-3451
- **Mailing address:** 1924 JUAN TABO BLVD NE STE C, ALBUQUERQUE, NM 87112-3358
- **Mailing address phone:** (505) 293-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2019
- **Last updated:** 10/29/2019