Healthcare Provider Details

I. General information

NPI: 1841839099
Provider Name (Legal Business Name): NAOMI LYNN AMADOR RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 01/04/2020
Certification Date: 01/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GOLF DR
CLOVIS NM
88101-3145
US

IV. Provider business mailing address

1721 AVONDALE BLVD
CLOVIS NM
88101-5007
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-4745
  • Fax:
Mailing address:
  • Phone: 575-693-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3539
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: