Healthcare Provider Details

I. General information

NPI: 1376656637
Provider Name (Legal Business Name): B JOE ADAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MISSOURI AVE STE D
LAS CRUCES NM
88011-5091
US

IV. Provider business mailing address

2701 MISSOURI AVE STE D
LAS CRUCES NM
88011-5091
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-1500
  • Fax: 505-521-1529
Mailing address:
  • Phone: 505-522-1500
  • Fax: 505-521-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: