Healthcare Provider Details

I. General information

NPI: 1700907995
Provider Name (Legal Business Name): FARMINGTON ENDODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E 20TH ST
FARMINGTON NM
87401-4205
US

IV. Provider business mailing address

PO BOX 2932
FARMINGTON NM
87499-2932
US

V. Phone/Fax

Practice location:
  • Phone: 505-793-4976
  • Fax: 505-327-6156
Mailing address:
  • Phone: 505-793-4976
  • Fax: 505-327-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDD2551
License Number StateNM

VIII. Authorized Official

Name: MRS. DEANN RISHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-793-4976