Healthcare Provider Details

I. General information

NPI: 1528920212
Provider Name (Legal Business Name): DARREN HALTOM SPECIALTY PARTNERS OF NM II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 BONITA ST STE A
GRANTS NM
87020-2103
US

IV. Provider business mailing address

8300 CARMEL AVE NE STE 602
ALBUQUERQUE NM
87122-3150
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-3443
  • Fax:
Mailing address:
  • Phone: 505-878-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL RICHARDSON
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 214-934-7995