Healthcare Provider Details

I. General information

NPI: 1629305743
Provider Name (Legal Business Name): M. THOMAS ASHBROOK, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE N7
SANTA FE NM
87505-2111
US

IV. Provider business mailing address

2019 GALISTEO ST STE N7
SANTA FE NM
87505-2111
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-9816
  • Fax: 505-982-3707
Mailing address:
  • Phone: 505-982-9816
  • Fax: 505-982-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1634
License Number StateNM

VIII. Authorized Official

Name: DR. MELVIN THOMAS ASHBROOK
Title or Position: OWNER
Credential: DDS, PC
Phone: 505-982-9816