Individual
CHARLES TATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1801 CAMINO DE SALUD NE, SUITE 1200, ALBUQUERQUE, NM 87102-4516
(505) 925-4031
(505) 246-6019
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD 1861
NM
Other
Enumeration date
10/17/2005
Last updated
03/22/2017
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