Healthcare Provider Details

I. General information

NPI: 1497629505
Provider Name (Legal Business Name): GENTLE WAVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 JAGER DR NE STE C1
RIO RANCHO NM
87144-5715
US

IV. Provider business mailing address

4405 JAGER DR NE STE C1
RIO RANCHO NM
87144-5715
US

V. Phone/Fax

Practice location:
  • Phone: 505-405-9300
  • Fax:
Mailing address:
  • Phone: 505-405-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY M GARCIA
Title or Position: DENTAL HYGIENIST
Credential: RDH
Phone: 505-405-9300