Orthodental PC

NPI #1750622072 in Gallup, New Mexico

Provider Information

NPI Number: 1750622072
Entity Type: Organization
Organization Name: Orthodental PC
Primary Specialty: Dentist
Enumeration Date: Mar 12, 2013
Last Updated: Mar 12, 2013

Practice Location

Address: 1748 W MALONEY AVE
City: Gallup
State: New Mexico
ZIP Code: 87301-3333
Phone: (505) 863-8100

Authorized Official

Name: JOSEPH A WILSON, DMD, MSD
Title: OWNER
Phone: (505) 325-8858

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X
Dentist	122300000X	Primary

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