Healthcare Provider Details

I. General information

NPI: 1629596705
Provider Name (Legal Business Name): DDS CATALYST FARMINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N BUTLER AVE STE 104
FARMINGTON NM
87401-6430
US

IV. Provider business mailing address

3501 N BUTLER AVE STE 104
FARMINGTON NM
87401-6430
US

V. Phone/Fax

Practice location:
  • Phone: 505-564-4470
  • Fax: 505-325-9707
Mailing address:
  • Phone: 505-564-4470
  • Fax: 505-325-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREW ASHBY
Title or Position: OWNER
Credential: DMD
Phone: 303-810-2890