| Pediatric Dental Specialist Of New Mexico Llc | |
|
2450 South Telshor Memorial Medical Hospital Las Cruces NM 88011-7594 | |
| (575) 621-0800 | |
| (575) 373-3091 |
| Full Name | Pediatric Dental Specialist Of New Mexico Llc |
|---|---|
| Speciality | Dentist |
| Location | 2450 South Telshor, Las Cruces, New Mexico |
| Authorized Official Name and Position | Peter Andrew Hayes (PEDIATRIC DENTAL SPECIALIST) |
| Authorized Official Contact | 5756210800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Specialist Of New Mexico Llc 5475 Remington Road Dr. Peter Hayes Las Cruces NM 88011-7594 Ph: (575) 621-0800 | Pediatric Dental Specialist Of New Mexico Llc 2450 South Telshor Memorial Medical Hospital Las Cruces NM 88011-7594 Ph: (575) 621-0800 |
| NPI Number | 1154624401 |
|---|---|
| Provider Enumeration Date | 12/08/2010 |
| Last Update Date | 12/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154624401 | NPI | - | NPPES |
| 92472214 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DD2233 (New Mexico) | Primary |
| 122300000X | Dentist | (* (Not Available)) | Secondary |
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