Healthcare Provider Details

I. General information

NPI: 1104939073
Provider Name (Legal Business Name): ROBERT ANTHONY FILICE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST H-3
SANTA FE NM
87505-2106
US

IV. Provider business mailing address

3 MANZANO LN
SANTA FE NM
87508-8214
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-5353
  • Fax:
Mailing address:
  • Phone: 505-466-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1554
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: