Smalley, Jack Owen

Smalley, Jack Owen is an sole proprietor health care provider with primary practice located at 2650 E Pinon Frontage Rd Bldg 300 , Farmington NM 87402-5084. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Smalley, Jack Owen can be contacted via phone (505) 327-3331.

Contact Information

Primary practice address
2650 E Pinon Frontage Rd Bldg 300 Farmington NM 87402-5084
Phone: (505) 327-3331
Fax: (505) 327-0873
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X DD1918 New Mexico
Dental Providers / General Practice 1223G0001X DD1918 New Mexico

Profile Details

NPI number 1487611331
LBN Legal business name Smalley, Jack Owen
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 26th, 2006
Last updated Nov 1st, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487611331 NPPES
New Mexico MEDICAID 84279826

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