| Orthodental Pc | |
|
1748 W Maloney Ave Gallup NM 87301-3333 | |
| (505) 863-8100 | |
| (505) 863-8064 |
| Full Name | Orthodental Pc |
|---|---|
| Speciality | Dentist |
| Location | 1748 W Maloney Ave, Gallup, New Mexico |
| Authorized Official Name and Position | Joseph A Wilson (OWNER) |
| Authorized Official Contact | 5053258858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Orthodental Pc 1748 W Maloney Ave Gallup NM 87301-3333 Ph: (505) 863-8100 | Orthodental Pc 1748 W Maloney Ave Gallup NM 87301-3333 Ph: (505) 863-8100 |
| NPI Number | 1750622072 |
|---|---|
| Provider Enumeration Date | 03/12/2013 |
| Last Update Date | 03/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750622072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD3399 (New Mexico) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DD3399 (New Mexico) | Secondary |
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