Healthcare Provider Details

I. General information

NPI: 1376275818
Provider Name (Legal Business Name): SUCCESS SMILES ORTHODONTICS SANTA FE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 KIVA CT STE A
SANTA FE NM
87505-6123
US

IV. Provider business mailing address

8216 LOUISIANA BLVD NE
ALBUQUERQUE NM
87113-2105
US

V. Phone/Fax

Practice location:
  • Phone: 505-569-6639
  • Fax: 505-666-5513
Mailing address:
  • Phone: 505-569-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LIGIA ELENA PADILLA
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 505-569-6639