Healthcare Provider Details

I. General information

NPI: 1720160609
Provider Name (Legal Business Name): PETER J TAFOYA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 KIVA CT STE D
SANTA FE NM
87505-5994
US

IV. Provider business mailing address

404 KIVA CT STE D
SANTA FE NM
87505-5994
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-3804
  • Fax: 505-988-5809
Mailing address:
  • Phone: 505-988-3804
  • Fax: 505-988-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: