Individual
GRANT SKOUSEN ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4041 RIDGE ROCK RD SE, RIO RANCHO, NM 87124-7626
(505) 891-4510
Mailing address
4041 RIDGE ROCK RD SE, RIO RANCHO, NM 87124-7626
(505) 891-4510
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4692
NM
Other
Enumeration date
05/25/2017
Last updated
07/21/2022
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