Healthcare Provider Details

I. General information

NPI: 1508693532
Provider Name (Legal Business Name): SI HUI VALERIE TAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 ANTHONY DR STE 2
ANTHONY NM
88021-9157
US

IV. Provider business mailing address

1405 S VALLEY DR # 300
LAS CRUCES NM
88005-3132
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2024-0336
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: