Healthcare Provider Details

I. General information

NPI: 1679561716
Provider Name (Legal Business Name): DONNA KIDBY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 S SAINT FRANCIS DR
SANTA FE NM
87505-4031
US

IV. Provider business mailing address

2108 CALLE DE SEBASTIAN
SANTA FE NM
87505-7314
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2178
  • Fax:
Mailing address:
  • Phone: 505-983-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2274
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDD2274
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: