Individual
DR. JIM R. FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
ALBUQUERQUE INDIAN HEALTH SERVICE DENTAL CLINIC, 9169 COORS ROAD NW, ALBUQUERQUE, NM 87193
(505) 346-2306
Mailing address
PO BOX 411957, MELBOURNE, FL 32941-1957
(321) 638-1219
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3274
NC
Other
Enumeration date
10/02/2006
Last updated
05/10/2026
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