Organization
TASKER HATCH ROWAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING MANAGER)
(505) 850-3769
Entity
Organization
Contact information
Practice address
106 MAIN ST NE, LOS LUNAS, NM 87031-7559
(505) 865-1999
(505) 899-4804
Mailing address
8201 GOLF COURSE RD NW STE C3, ALBUQUERQUE, NM 87120-5805
(505) 892-9010
(505) 899-4804
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2829
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22535268
—
NM
Enumeration date
04/05/2012
Last updated
05/24/2022
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