Individual
JUSTIN JACK NYLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1392 WEIMER RD STE A, TAOS, NM 87571-5308
(575) 758-8654
(575) 737-0970
Mailing address
1392 WEIMER RD. SUITE A, TAOS, NM 87571
(575) 758-8654
(575) 737-0970
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10112
CO
1223G0001X
General Practice Dentistry
Primary
DD3407
NM
Other
Enumeration date
02/04/2010
Last updated
12/13/2015
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