Individual
JACOB SHONOTA COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2525 E 30TH ST, FARMINGTON, NM 87401-4503
(505) 327-4863
Mailing address
2525 E 30TH ST, FARMINGTON, NM 87401-4503
(505) 327-4863
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
062584
NM
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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