Individual
DAN LAFFERTY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4550 EUBANK BLVD NE STE 101, ALBUQUERQUE, NM 87111-2565
(505) 292-8588
(505) 292-3100
Mailing address
554 KEILY STREET, BUREAU OF MEDICINE & SURGERY - CENTRALIZED CREDENTIALI, JACKSONVILLE, FL 32212
(757) 953-7011
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10121
OR
122300000X
Dentist
DD4838
NM
Other
Enumeration date
08/13/2014
Last updated
08/18/2020
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