Healthcare Provider Details

I. General information

NPI: 1679698690
Provider Name (Legal Business Name): GENE ALAN GABALDON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 S LOCUST STE C
LAS CRUCES NM
88001
US

IV. Provider business mailing address

2460 S LOCUST STE C
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-0306
  • Fax: 505-522-1132
Mailing address:
  • Phone: 505-521-0306
  • Fax: 505-522-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberNM 1704
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: