Organization
JEFFREY RAY MATTILA, D.D.S,P.C.
Active
Other names
Southwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY RAY MATTILA D.D.S. (PRESIDENT)
(505) 287-2000
Entity
Organization
Contact information
Practice address
200 LINCOLN AVE, GRANTS, NM 87020-2828
(505) 287-2000
Mailing address
200 LINCOLN AVE, GRANTS, NM 87020-2828
(505) 287-2000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1754
NM
Other
Enumeration date
04/17/2007
Last updated
08/22/2020
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