Healthcare Provider Details

I. General information

NPI: 1922484922
Provider Name (Legal Business Name): GENTLE CARE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 N MAIN ST
LAS CRUCES NM
88001-1152
US

IV. Provider business mailing address

2980 N MAIN ST
LAS CRUCES NM
88001-1152
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-3722
  • Fax: 575-524-9826
Mailing address:
  • Phone: 575-524-3722
  • Fax: 575-524-9826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4333
License Number StateOK

VIII. Authorized Official

Name: DR. DOMINIC MARKETTO THOMAS
Title or Position: DENTIST
Credential: DDS
Phone: 575-524-3722