MEDICARE: DALLAS GRASSBAUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		NM

General Provider Information

NPI Number	:	1457840092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS GRASSBAUGH

Provider Business Mailing Address
First Line	:	2305 RENARD PL SE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 RENARD PL SE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4258
Country	:	US
Telephone Number	:	505-518-1471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	02/23/2026

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Directions to “ DALLAS GRASSBAUGH ” Practice Location

Language	Start Address	Practice Location

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