Healthcare Provider Details

I. General information

NPI: 1184608374
Provider Name (Legal Business Name): ERNEST L. STROMEYER DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 EAST 20TH STREET
FARMINGTON NM
87401
US

IV. Provider business mailing address

2200 EAST 20TH STREET
FARMINGTON NM
87401
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4872
  • Fax: 505-327-4915
Mailing address:
  • Phone: 505-327-4872
  • Fax: 505-327-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1082
License Number StateNM

VIII. Authorized Official

Name: DR. ERNEST LEE STROMEYER
Title or Position: ORTHODONTIST
Credential: DDS MS
Phone: 505-327-4872