Healthcare Provider Details

I. General information

NPI: 1134433865
Provider Name (Legal Business Name): DEVIN KYLE GIRON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEVIN KYLE GIRON DDS

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

01 SAGEBRUSH STREET
ISLETA NM
87022-0640
US

IV. Provider business mailing address

P.O BOX 640
ISLETA NM
87022-0640
US

V. Phone/Fax

Practice location:
  • Phone: 506-869-3200
  • Fax: 505-869-4881
Mailing address:
  • Phone: 505-869-3200
  • Fax: 505-869-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD3314
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: