Healthcare Provider Details

I. General information

NPI: 1669714184
Provider Name (Legal Business Name): KAITLYN NICOLE DARCY DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 EUBANK BLVD NE
ALBUQUERQUE NM
87112-1395
US

IV. Provider business mailing address

2801 EUBANK BLVD NE
ALBUQUERQUE NM
87112-1395
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-9606
  • Fax:
Mailing address:
  • Phone: 505-299-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD4418
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: