Organization
SAN JUAN COLLEGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL SPENCER (PRESIDENT)
(505) 566-3209
Entity
Organization
Contact information
Practice address
4601 COLLEGE BLVD, DENTAL CLINIC, FARMINGTON, NM 87402-4609
(505) 566-3126
(505) 566-3790
Mailing address
4601 COLLEGE BLVD, FARMINGTON, NM 87402-4609
(505) 566-3126
(505) 566-3790
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD-2461
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59457538
—
NM
Enumeration date
05/14/2008
Last updated
05/14/2008
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