Healthcare Provider Details

I. General information

NPI: 1831506831
Provider Name (Legal Business Name): DARREN HALTOM SPECIALTY PARTNERS OF NM II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10433 LAGRIMA DE ORO
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

10433 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-3727
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4458
  • Fax: 505-299-4450
Mailing address:
  • Phone: 505-299-4458
  • Fax: 505-299-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD2090
License Number StateNM

VIII. Authorized Official

Name: MS. KRYSTAL RICHARDSON
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 214-934-7995