Organization
A TO Z CHILDREN'S DENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCELLUS GLADNEY D.M.D. (PRESIDENT)
(505) 876-1065
Entity
Organization
Contact information
Practice address
805 E HIGH ST, GRANTS, NM 87020-2448
(505) 876-1065
Mailing address
805 E HIGH ST, PO BOX 638, GRANTS, NM 87020-2448
(505) 876-1065
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD1966
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8615
—
NM
05
—
Z9089
—
NM
Enumeration date
06/18/2007
Last updated
08/22/2020
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