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General NPI Number Information
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NPI Number | 1679108815
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Entity Type | Organization
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Legal Business Name | BELEN FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 1501 E RIVER RD
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City | BELEN
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State | NM
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Zip | 87002-7429
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Country | US
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Telephone | 505-864-6969
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Fax | 505-864-9310
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Provider Business Mailing Address
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Address Line | 1501 E RIVER RD
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City | BELEN
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State | NM
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Zip | 87002-7429
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Country | US
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Telephone | 505-864-6969
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Fax | 505-864-9310
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JAYSON GARCIA-GURULE
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Credential | DDS
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Telephone | 505-615-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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