Dr. Jeremy R Dockstader, D.M.D.
Dentist in Albuquerque, NM. Individual provider (NPI-1).
NPI number1174772016
StatusActive
Last updated in NPPESJan 28, 2013
Details
- NPI
- 1174772016
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jeremy R Dockstader
- Credential
- D.M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 16, 2008
- Last updated
- Jan 28, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DD3444 | NM | Yes |
| 1223G0001X | Dentist, General Practice | 7106444-9922 | UT |
Practice location
4701 Lomas Blvd NeAlbuquerque, NM 87110-6233
Phone 505-232-2273
Mailing address
4701 Lomas BlvdAlbuquerque, NM 87110
Phone 505-232-2273
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