# TAOS DENTAL GROUP

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

## Provider details

- **NPI number:** 1609267632
- **Authorized official:** DR. JUSTIN NYLUND DDS (DENTIST)
- **Authorized official phone:** (575) 758-8654

## Contact information

- **Practice address:** 1392 WEIMER RD, TAOS, NM 87571-5307
- **Practice address phone:** (575) 758-8654
- **Practice address fax:** (575) 737-0970
- **Mailing address:** 1392 WEIMER RD, TAOS, NM 87571-5307
- **Mailing address phone:** (575) 758-8654
- **Mailing address fax:** (575) 737-0970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD1078 | NM | — |
| 1223G0001X | General Practice Dentistry | DD3407 | NM | Yes |

## Other

- **Enumeration date:** 02/12/2015
- **Last updated:** 02/12/2015