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
2421 CABEZON BLVD SE, RIO RANCHO, NM 87124-1515
(505) 884-5437
Mailing address
325 S HIGLEY RD #130, GILBERT, AZ 85296
(505) 850-3769
(505) 890-2949
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/10/2010
Last updated
05/23/2022
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