Organization
TASKER HATCH ROWAN LLC
Active
Other names
Just for Grins
Organization subpart
No
Provider details
NPI number
Authorized official
KUSHBOO KUMAR (CREDENTIALING SPECIALIST)
(916) 877-7450
Entity
Organization
Contact information
Practice address
2101 TRINITY DRIVE STE P, LOS ALAMOS, NM 87544-4103
(505) 428-7878
Mailing address
325 S HIGLEY RD #130, GILBERT, AZ 85296-4703
(916) 877-7450
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
06/14/2024
Last updated
06/14/2024
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