Organization
TASKER HATCH ROWAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING MANAGER)
(505) 850-3769
Entity
Organization
Contact information
Practice address
111 COORS BLVD NW STE E6, ALBUQUERQUE, NM 87121-2009
(505) 892-9010
(505) 899-4804
Mailing address
325 S HIGLEY #130, GILBERT, AZ 85296
(505) 850-3769
(505) 890-2949
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3168
NM
Other
Enumeration date
09/24/2014
Last updated
05/24/2022
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