Healthcare Provider Details

I. General information

NPI: 1376533216
Provider Name (Legal Business Name): STRIDER ARAGORN MCCASH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27479 HWY 64
ANGEL FIRE NM
87710
US

IV. Provider business mailing address

HC 71 BOX 85
EAGLE NEST NM
87718-9704
US

V. Phone/Fax

Practice location:
  • Phone: 575-377-1383
  • Fax:
Mailing address:
  • Phone: 575-377-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2040
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: