Healthcare Provider Details

I. General information

NPI: 1124331269
Provider Name (Legal Business Name): MICHAEL D LAW D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 CAMINO COYOTE STE A
LAS CRUCES NM
88011-3001
US

IV. Provider business mailing address

4141 CAMINO COYOTE STE A
LAS CRUCES NM
88011-3001
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-5812
  • Fax:
Mailing address:
  • Phone: 575-524-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD3348
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: