Organization
SJT PEDIATRIC DENTISTRY LLC
Active
Other names
ABQ Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING MANAGER)
(505) 850-3769
Entity
Organization
Contact information
Practice address
4620 JEFFERSON LN NE STE C, ALBUQUERQUE, NM 87109-2149
(505) 888-3520
Mailing address
4620 JEFFERSON LN NE STE C, ALBUQUERQUE, NM 87109-2149
(505) 850-3769
(505) 890-2949
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
03/25/2024
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