# JEFFREY RAY MATTILA, D.D.S,P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southwest Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548486079
- **Authorized official:** DR. JEFFREY RAY MATTILA D.D.S. (PRESIDENT)
- **Authorized official phone:** (505) 287-2000

## Contact information

- **Practice address:** 200 LINCOLN AVE, GRANTS, NM 87020-2828
- **Practice address phone:** (505) 287-2000
- **Mailing address:** 200 LINCOLN AVE, GRANTS, NM 87020-2828
- **Mailing address phone:** (505) 287-2000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD1754 | NM | Yes |

## Other

- **Enumeration date:** 04/17/2007
- **Last updated:** 08/22/2020