Organization
CDB RIO BRAVO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONAH FOUTZ (DDS)
(505) 850-0305
Entity
Organization
Contact information
Practice address
1625 RIO BRAVO BLVD SW, ALBUQUERQUE, NM 87105-6057
(505) 850-0305
Mailing address
7120 CALLE ALEGRIA NE, ALBUQUERQUE, NM 87113-1368
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD3662
NM
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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