Healthcare Provider Details

I. General information

NPI: 1255814968
Provider Name (Legal Business Name): SOCORRO DENTAL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 SARA RD SE STE C
RIO RANCHO NM
87124-1860
US

IV. Provider business mailing address

1594 SARA RD SE STE C
RIO RANCHO NM
87124-1860
US

V. Phone/Fax

Practice location:
  • Phone: 877-989-7413
  • Fax: 505-226-9697
Mailing address:
  • Phone: 505-273-3220
  • Fax: 505-226-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GEORGE HANNA
Title or Position: OWNER
Credential:
Phone: 505-273-3220