Individual
JESSICA GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4800 CUTLER AVE NE, ALBUQUERQUE, NM 87110-4033
(505) 881-1234
Mailing address
10212 HACKAMORE PL SW, ALBUQUERQUE, NM 87121-8931
(505) 620-0552
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH4066
NM
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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