Healthcare Provider Details

I. General information

NPI: 1073113197
Provider Name (Legal Business Name): ARAGON PEDIATRIC DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CARMEL AVE NE STE 60
ALBUQUERQUE NM
87122-3147
US

IV. Provider business mailing address

8300 CARMEL AVE NE STE 60
ALBUQUERQUE NM
87122-3147
US

V. Phone/Fax

Practice location:
  • Phone: 505-878-0700
  • Fax:
Mailing address:
  • Phone: 505-878-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DARREN HALTOM
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 505-331-7473