Healthcare Provider Details

I. General information

NPI: 1376846352
Provider Name (Legal Business Name): MELISSA HUERTA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 BEARCAT DR
LAS CRUCES NM
88001-1597
US

IV. Provider business mailing address

2633 BEARCAT
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-8358
  • Fax:
Mailing address:
  • Phone: 575-650-8358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number16671
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: