Organization
FOUR CORNERS FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER ANTHONY MANN D.D.S. (DENTIST)
(505) 564-4470
Entity
Organization
Contact information
Practice address
383 CANYONVIEW DR, FARMINGTON, NM 87401-8629
(505) 564-4470
Mailing address
3501 N BUTLER AVE STE 114, FARMINGTON, NM 87401-6429
(505) 564-4470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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