Healthcare Provider Details

I. General information

NPI: 1144460486
Provider Name (Legal Business Name): ERNEST LEE STROMEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 20TH ST
FARMINGTON NM
87401-8904
US

IV. Provider business mailing address

2200 E 20TH ST
FARMINGTON NM
87401-8904
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4872
  • Fax:
Mailing address:
  • Phone: 505-327-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberNM1082
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: