| Just Clean Smiles, Llc | |
|
1204 Main St Ne Suite B Los Lunas NM 87031-7409 | |
| (505) 565-0609 | |
| (505) 565-0709 |
| Full Name | Just Clean Smiles, Llc |
|---|---|
| Speciality | Dental Hygienist |
| Location | 1204 Main St Ne, Los Lunas, New Mexico |
| Authorized Official Name and Position | Donna M Riordan (MANAGER/DENTAL HYGIENIST) |
| Authorized Official Contact | 5055650609 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Just Clean Smiles, Llc 1204 Main St Ne Suite B Los Lunas NM 87031-7409 Ph: (505) 565-0609 | Just Clean Smiles, Llc 1204 Main St Ne Suite B Los Lunas NM 87031-7409 Ph: (505) 565-0609 |
| NPI Number | 1609176965 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 03/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609176965 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1503 (New Mexico) | Secondary |
| 124Q00000X | Dental Hygienist | DH-373 (New Mexico) | Primary |
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