Healthcare Provider Details

I. General information

NPI: 1902736747
Provider Name (Legal Business Name): FARNSWORTH ORTHODONTICS LAS CRUCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 COMMERCE DR STE B
LAS CRUCES NM
88011-8448
US

IV. Provider business mailing address

1160 COMMERCE DR STE B
LAS CRUCES NM
88011-8448
US

V. Phone/Fax

Practice location:
  • Phone: 575-640-3367
  • Fax:
Mailing address:
  • Phone: 575-640-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HEATHER BRIANNA BEAL
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 325-212-4793