Individual
JACOB KUALAPAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDH, CDHC
Contact information
Practice address
1776 MONTANO RD NW, LOS RANCHOS, NM 87107-3245
(505) 615-0951
Mailing address
1080 SAND DUNE RD NE, RIO RANCHO, NM 87144-8051
(505) 503-3544
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH2912
NM
Other
Enumeration date
08/07/2019
Last updated
08/07/2019
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