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1000 Blue Hole Rd Santa Rosa NM 88435-2533 | |
| (505) 718-6899 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1000 Blue Hole Rd, Santa Rosa, New Mexico |
| Authorized Official Name and Position | Raymond Frank Collins (PRESIDENT) |
| Authorized Official Contact | 5057186899 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1000 Blue Hole Rd Santa Rosa NM 88435-2533 Ph: (505) 718-6899 | 1000 Blue Hole Rd Santa Rosa NM 88435-2533 Ph: (505) 718-6899 |
| NPI Number | 1740484641 |
|---|---|
| Provider Enumeration Date | 06/13/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740484641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD2469 (New Mexico) | Primary |
| 1223G0001X | Dentist - General Practice | DD2208 (New Mexico) | Secondary |