Healthcare Provider Details

I. General information

NPI: 1942816590
Provider Name (Legal Business Name): DEMING SOUTHWEST DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S GOLD AVE
DEMING NM
88030-4161
US

IV. Provider business mailing address

710 S GOLD AVE
DEMING NM
88030-4161
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-1400
  • Fax: 575-546-1400
Mailing address:
  • Phone: 407-729-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA VALENTINA MARTINEZ MORALES
Title or Position: MANAGER
Credential: DMD
Phone: 407-729-2361