Organization
JUAN TABO DENTISTRY LLC
Active
Other names
Delicate Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
1924 JUAN TABO BLVD NE STE C, ALBUQUERQUE, NM 87112-3358
(505) 293-3451
Mailing address
1924 JUAN TABO BLVD NE STE C, ALBUQUERQUE, NM 87112-3358
(505) 293-3451
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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