Healthcare Provider Details

I. General information

NPI: 1801964234
Provider Name (Legal Business Name): MARK A CAREY DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N MAIN STREET
ROSWELL NM
88201
US

IV. Provider business mailing address

824 N MAIN STREET
ROSWELL NM
88201
US

V. Phone/Fax

Practice location:
  • Phone: 505-622-4455
  • Fax: 505-624-2556
Mailing address:
  • Phone: 505-622-4455
  • Fax: 505-624-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberNM1579
License Number StateNM

VIII. Authorized Official

Name: DR. MARK A CAREY
Title or Position: OFFICER
Credential: DDS
Phone: 505-622-4455