Embudo Dental Center Llc | |
1102 State Highway 68 Embudo NM 87531-0037 | |
(505) 579-4680 | |
(505) 579-4074 |
Full Name | Embudo Dental Center Llc |
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Speciality | Clinic/center - Dental |
Location | 1102 State Highway 68, Embudo, New Mexico |
Authorized Official Name and Position | Kellie A Harris (OWNER/DENTIST) |
Authorized Official Contact | 5055794680 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Embudo Dental Center Llc Po Box 37 1102 State Highway 68 Embudo NM 87531-0037 Ph: (505) 579-4680 | Embudo Dental Center Llc 1102 State Highway 68 Embudo NM 87531-0037 Ph: (505) 579-4680 |
NPI Number | 1679017453 |
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Provider Enumeration Date | 12/13/2016 |
Last Update Date | 12/13/2016 |
Identifier | Type | State | Issuer |
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1679017453 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | DD1953 (New Mexico) | Primary |
261QD0000X | Clinic/center - Dental | DD1074 (New Mexico) | Secondary |