Organization
CHAMA VALLEY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT ALLEN (DENTIST)
(575) 756-2901
Entity
Organization
Contact information
Practice address
451 MAPLE AVE., CHAMA, NM 87520
(575) 756-2901
Mailing address
PO BOX 276, CHAMA, NM 87520-0276
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1550
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00085538
—
NM
Enumeration date
03/08/2012
Last updated
03/08/2012
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