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General NPI Number Information
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NPI Number | 1205450939
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Entity Type | Individual
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Provider Name | AISLINN B GROVER
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | INDIAN SERVICE RTE 140 & INDIAN SERVICE ROUTE 125
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City | PINEHILL
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State | NM
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Zip | 87357
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Country | US
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Telephone | 505-806-0025
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 496
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City | BLUEWATER
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State | NM
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Zip | 87005-0496
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Country | US
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Telephone | 575-915-5369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH3598
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License Number State | NM
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