Organization
CDB 550 LLC
Active
Other names
DBA Celebrate Dental and Braces
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONAH L FOUTZ DD3662 (OWNER)
(505) 550-0305
Entity
Organization
Contact information
Practice address
120 E HIGHWAY 550, BERNALILLO, NM 87004-5967
(505) 550-0503
Mailing address
120 E HIGHWAY 550, BERNALILLO, NM 87004-5967
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3662
NM
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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