Organization
GALLUP INDIAN MEDICAL CENTER
Active
Other names
Fort Wingate Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BENNIE C. YAZZIE (ACTING CEO)
(505) 722-1000
Entity
Organization
Contact information
Practice address
520 B SHUSH DRIVE, EXIT 33 STATE ROAD 400, FT . WINGATE, NM 87316
(505) 722-1770
(505) 722-1796
Mailing address
516 E. NIZHONI BLVD, GALLUP, NM 87301-1337
(505) 722-1770
(505) 722-1796
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
9435
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27603725
—
NM
Enumeration date
06/12/2007
Last updated
07/22/2008
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