| Outreach Dental, Llc | |
|
1700 Helena Dr Gallup NM 87301-5610 | |
| (505) 863-7887 | |
| (505) 863-7887 |
| Full Name | Outreach Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 1700 Helena Dr, Gallup, New Mexico |
| Authorized Official Name and Position | Stephen Scot Graham (OWNER) |
| Authorized Official Contact | 5058637887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Outreach Dental, Llc Po Box 969 Gallup NM 87305-0969 Ph: (505) 863-7887 | Outreach Dental, Llc 1700 Helena Dr Gallup NM 87301-5610 Ph: (505) 863-7887 |
| NPI Number | 1982033700 |
|---|---|
| Provider Enumeration Date | 11/02/2013 |
| Last Update Date | 11/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982033700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD1995 (New Mexico) | Primary |
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