| Divine Dental Centre | |
|
925 Mills Ave Las Vegas NM 87701-4047 | |
| (505) 454-8483 | |
| Not Available |
| Full Name | Divine Dental Centre |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 925 Mills Ave, Las Vegas, New Mexico |
| Authorized Official Name and Position | Esmael Robert Valdez (OWNER) |
| Authorized Official Contact | 5054548483 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Dental Centre 925 Mills Ave Las Vegas NM 87701-4047 Ph: (505) 454-8483 | Divine Dental Centre 925 Mills Ave Las Vegas NM 87701-4047 Ph: (505) 454-8483 |
| NPI Number | 1164547204 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164547204 | NPI | - | NPPES |
| 44456310 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD2351 (New Mexico) | Primary |
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