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1594 Sara Rd Se Ste C Rio Rancho NM 87124-1860 | |
| (877) 989-7413 | |
| (505) 226-9697 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1594 Sara Rd Se Ste C, Rio Rancho, New Mexico |
| Authorized Official Name and Position | George Hanna (OWNER) |
| Authorized Official Contact | 5052733220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1594 Sara Rd Se Ste C Rio Rancho NM 87124-1860 Ph: (505) 273-3220 | 1594 Sara Rd Se Ste C Rio Rancho NM 87124-1860 Ph: (877) 989-7413 |
| NPI Number | 1255814968 |
|---|---|
| Provider Enumeration Date | 09/09/2018 |
| Last Update Date | 03/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255814968 | NPI | - | NPPES |
| DD4651 | Other | NM | DENTAL LICENSE |
| 90288840 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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