| Southwest Dental | |
|
200 Lincoln Ave Grants NM 87020-2828 | |
| (505) 287-2000 | |
| Not Available |
| Full Name | Southwest Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 200 Lincoln Ave, Grants, New Mexico |
| Authorized Official Name and Position | Jeffrey Ray Mattila (PRESIDENT) |
| Authorized Official Contact | 5052872000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Dental 200 Lincoln Ave Grants NM 87020-2828 Ph: (505) 287-2000 | Southwest Dental 200 Lincoln Ave Grants NM 87020-2828 Ph: (505) 287-2000 |
| NPI Number | 1548486079 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548486079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD1754 (New Mexico) | Primary |
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