Dr. Nick A Desantis
Dentist, General Practice in Gallup, NM. Individual provider (NPI-1).
NPI number1679606834
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1679606834
- Entity type
- Individual (NPI-1)
- Name
- Dr. Nick A Desantis
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 14, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 1345 | NM | Yes |
Practice location
1801 Redrock DrGallup, NM 87301-5655
Phone 505-863-4457 · Fax 505-722-4310
Mailing address
1801 Redrock DrGallup, NM 87301-5655
Phone 505-863-4457 · Fax 505-722-4310
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