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Organization
GALLUP INDIAN MEDICAL CENTER
Active
Organization
GALLUP INDIAN MEDICAL CENTER
Active
Other names
Fort Wingate Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BENNIE C. YAZZIE (ACTING CEO)
(505) 722-1000
Entity
Organization
Contact information
Practice address
520 B SHUSH DRIVE, EXIT 33 STATE ROAD 400, FT . WINGATE, NM 87316
(505) 722-1770
(505) 722-1796
Mailing address
516 E. NIZHONI BLVD, GALLUP, NM 87301-1337
(505) 722-1770
(505) 722-1796
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
9435
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27603725
—
NM
Enumeration date
06/12/2007
Last updated
07/22/2008
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