Organization
OUTREACH DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN SCOT GRAHAM D.D.S. (OWNER)
(505) 863-7887
Entity
Organization
Contact information
Practice address
1700 HELENA DR, GALLUP, NM 87301-5610
(505) 863-7887
(505) 863-7887
Mailing address
PO BOX 969, GALLUP, NM 87305-0969
(505) 863-7887
(505) 863-7887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1995
NM
Other
Enumeration date
11/02/2013
Last updated
11/02/2013
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