Gallup Dental Group
Dentist in Gallup, NM. Organization (NPI-2).
NPI number1235457607
StatusActive
Last updated in NPPESMay 11, 2010
Details
- NPI
- 1235457607
- Entity type
- Organization (NPI-2)
- Legal business name
- Gallup Dental Group
- Organization subpart
- No
- Enumeration date
- May 11, 2010
- Last updated
- May 11, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DD1562 | NM | Yes |
Practice location
1421 Us 491Gallup, NM 87301
Phone 505-863-8000
Mailing address
1312 Redrock DrGallup, NM 87301-5686
Phone 505-979-2023
Authorized official
Michael Kory Rowberry
Owner
5058638000
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