Healthcare Provider Details

I. General information

NPI: 1730092479
Provider Name (Legal Business Name): JULIE'S MOBILE DENTAL HYGIENE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SACRED VISTA ROAD
EL PRADO NM
87529
US

IV. Provider business mailing address

PO BOX 1605
EL PRADO NM
87529-1605
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-9181
  • Fax:
Mailing address:
  • Phone: 575-770-9181
  • 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: JULIE ARNESON
Title or Position: OWNER
Credential: RDH
Phone: 575-770-9181