Individual
DR. JEREMY R DOCKSTADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4701 LOMAS BLVD NE, ALBUQUERQUE, NM 87110-6233
(505) 232-2273
Mailing address
4701 LOMAS BLVD, ALBUQUERQUE, NM 87110
(505) 232-2273
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3444
NM
1223G0001X
General Practice Dentistry
7106444-9922
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273267056
—
NM
Enumeration date
09/16/2008
Last updated
01/28/2013
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