Organization
DR. JACK O. SMALLEY DSS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEANZA D SONA RDA (OFFICE MANAGER)
(505) 327-3331
Entity
Organization
Contact information
Practice address
2650 E PINON FRONTAGE RD BLDG 300, FARMINGTON, NM 87402-5084
(505) 327-3331
(505) 327-0873
Mailing address
2650 E PINON FRONTAGE RD BLDG 300, FARMINGTON, NM 87402-5084
(505) 327-3331
(505) 327-0873
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84279826
—
NM
Enumeration date
11/01/2018
Last updated
11/01/2018
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