Healthcare Provider Details

I. General information

NPI: 1447481775
Provider Name (Legal Business Name): LAS CRUCES DENTAL HYGIENISTS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 CAMINO COYOTE
LAS CRUCES NM
88011
US

IV. Provider business mailing address

1463 PIONEER RDG
EL PASO TX
79912-8163
US

V. Phone/Fax

Practice location:
  • Phone: 575-562-6767
  • Fax: 575-562-6464
Mailing address:
  • Phone: 915-842-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberDH1388
License Number StateNM

VIII. Authorized Official

Name: MRS. LINDA A LOPEZ
Title or Position: OWNER/HYGIENIST
Credential: RDH
Phone: 915-355-7666