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
2801 EUBANK BLVD NE STE J, SUITE D2, ALBUQUERQUE, NM 87112-1300
(505) 299-9606
(505) 299-9740
Mailing address
2801 EUBANK BLVD NE, STE J, SUITE D2, ALBUQUERQUE, NM 87112-1034
(505) 299-9606
(505) 299-9740
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3168
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9177740
—
NM
05
—
9221857
—
NM
05
—
92935001
—
NM
Enumeration date
04/13/2010
Last updated
05/24/2022
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