Individual
DR. JACK OWEN SMALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2650 E PINON FRONTAGE RD BLDG 300, FARMINGTON, NM 87402-5084
(505) 327-3331
(505) 327-0873
Mailing address
2650 E PINON FRONTAGE RD BLDG 300, FARMINGTON, NM 87402-5084
(505) 327-3331
(505) 327-0873
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DD1918
NM
1223G0001X
General Practice Dentistry
Primary
DD1918
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84279826
—
NM
Enumeration date
04/26/2006
Last updated
11/01/2018
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