Organization
KIRTLAND FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
8521 CENTRAL AVE NE STE 101, ALBUQUERQUE, NM 87108-2501
(505) 266-5881
(505) 266-7172
Mailing address
2403 LACY LN, CARROLLTON, TX 75006-6514
(972) 869-3789
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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