Provider Demographics
NPI:1982890737
Name:JAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:JAL HOSPITAL DISTRICT
Other - Org Name:JAL DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-395-3400
Mailing Address - Street 1:PO DRAWER Z
Mailing Address - Street 2:310 CONTINENTAL ST SUITE 106
Mailing Address - City:JAL
Mailing Address - State:NM
Mailing Address - Zip Code:88252
Mailing Address - Country:US
Mailing Address - Phone:575-395-2205
Mailing Address - Fax:575-395-2209
Practice Address - Street 1:310 CONTINENTAL ST SUITE 106
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:575-395-2205
Practice Address - Fax:575-395-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty