Organization
SUNDANCE DENTAL CARE OF GALLUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE B SHAHEEN DDS (DENTIST/OWNER)
(505) 722-4422
Entity
Organization
Contact information
Practice address
1601 S SECOND ST, GALLUP, NM 87301-5816
(505) 722-4422
(505) 722-2060
Mailing address
1601 S SECOND ST, GALLUP, NM 87301-5816
(505) 722-4422
(505) 722-2060
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3503
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97524239
—
NM
Enumeration date
11/23/2011
Last updated
12/14/2016
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