Organization
TASKER HATCH ROWAN LLC
Active
Other names
Smiles for Kids
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING MANAGER)
(505) 850-3769
Entity
Organization
Contact information
Practice address
9201 EAGLE RANCH RD NW, ALBUQUERQUE, NM 87114-6032
(505) 892-9010
(505) 899-4804
Mailing address
325 S HIGLEY #130, GILBERT, AZ 85296
(505) 850-3769
(505) 890-2949
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2829
NM
1223P0221X
Pediatric Dentistry
DD2829
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22535268
—
NM
Enumeration date
03/24/2008
Last updated
06/16/2022
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