Organization
TASKER HATCH ROWAN LLC
Active
Other names
Route 66 Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING MANAGER)
(505) 850-3769
Entity
Organization
Contact information
Practice address
10221 CENTRAL AVE NE STE 103, ALBUQUERQUE, NM 87123
(505) 232-5437
(505) 254-7649
Mailing address
325 S HIGLEY RD #130, GILBERT, AZ 85296
(505) 850-3769
(505) 890-2949
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/10/2014
Last updated
05/23/2022
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