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Organization
GRANDE DENTISTRY LLC
Active
Organization
GRANDE DENTISTRY LLC
Active
Other names
Rio Rancho Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
2200 GRANDE BLVD SE STE A, RIO RANCHO, NM 87124-1695
(505) 891-1500
Mailing address
2200 GRANDE BLVD SE STE A, RIO RANCHO, NM 87124-1695
(972) 869-3789
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/22/2019
Last updated
10/30/2019
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