| Grande Dentistry Llc | |
|
2200 Grande Blvd Se Ste A Rio Rancho NM 87124-1695 | |
| (505) 891-1500 | |
| Not Available |
| Full Name | Grande Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2200 Grande Blvd Se Ste A, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Faith Gaskins (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grande Dentistry Llc 2200 Grande Blvd Se Ste A Rio Rancho NM 87124-1695 Ph: (972) 869-3789 | Grande Dentistry Llc 2200 Grande Blvd Se Ste A Rio Rancho NM 87124-1695 Ph: (505) 891-1500 |
| NPI Number | 1972166262 |
|---|---|
| Provider Enumeration Date | 04/22/2019 |
| Last Update Date | 10/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972166262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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