Healthcare Provider Details

I. General information

NPI: 1871799262
Provider Name (Legal Business Name): DR. JANSEN DONOGHUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 EUBANK BLVD NE
ALBUQUERQUE NM
87122-3225
US

IV. Provider business mailing address

4604 BENTGRASS MDWS NE
RIO RANCHO NM
87144-5757
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-6732
  • Fax:
Mailing address:
  • Phone: 505-514-8795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDRES182007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: