Healthcare Provider Details

I. General information

NPI: 1811020316
Provider Name (Legal Business Name): LINDA MARKLE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N BUTLER AVE
FARMINGTON NM
87401-6429
US

IV. Provider business mailing address

3 ROAD 3773
FARMINGTON NM
87401-3205
US

V. Phone/Fax

Practice location:
  • Phone: 505-564-4470
  • Fax:
Mailing address:
  • Phone: 406-653-1641
  • Fax: 405-653-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD5709
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7072
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: