| Northrise Dental Llc | |
|
2540 N Telshor Blvd Ste E Las Cruces NM 88011-8201 | |
| (575) 521-9375 | |
| (575) 521-2637 |
| Full Name | Northrise Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2540 N Telshor Blvd Ste E, Las Cruces, New Mexico |
| Authorized Official Name and Position | Jared Wallis (DENTIST/OWNER) |
| Authorized Official Contact | 5755219375 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northrise Dental Llc 2540 N Telshor Blvd Ste E Las Cruces NM 88011-8201 Ph: (575) 521-9375 | Northrise Dental Llc 2540 N Telshor Blvd Ste E Las Cruces NM 88011-8201 Ph: (575) 521-9375 |
| NPI Number | 1437622503 |
|---|---|
| Provider Enumeration Date | 01/10/2019 |
| Last Update Date | 01/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437622503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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