| San Miguel Dental | |
|
2503 Ridge Runner Rd Las Vegas NM 87701-4972 | |
| (505) 425-6434 | |
| (505) 425-6464 |
| Full Name | San Miguel Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2503 Ridge Runner Rd, Las Vegas, New Mexico |
| Authorized Official Name and Position | Wilfred B Pacheco (OWNER) |
| Authorized Official Contact | 5054256434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Miguel Dental 2503 Ridge Runner Rd Las Vegas NM 87701-4972 Ph: (505) 425-6434 | San Miguel Dental 2503 Ridge Runner Rd Las Vegas NM 87701-4972 Ph: (505) 425-6434 |
| NPI Number | 1033400601 |
|---|---|
| Provider Enumeration Date | 04/29/2011 |
| Last Update Date | 04/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033400601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DD1606 (New Mexico) | Primary |
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