Healthcare Provider Details

I. General information

NPI: 1255655841
Provider Name (Legal Business Name): DAVID PAULE FOLLMER DDS, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 69 BOX 30
ROCIADA NM
87742-9702
US

IV. Provider business mailing address

HC 69 BOX 30
ROCIADA NM
87742-9702
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-8929
  • Fax:
Mailing address:
  • Phone: 505-425-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-07199
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: