Healthcare Provider Details

I. General information

NPI: 1689847576
Provider Name (Legal Business Name): DENTAL FITNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 SAINT MICHAELS DR STE B
SANTA FE NM
87505-7674
US

IV. Provider business mailing address

444 SAINT MICHAELS DR STE B
SANTA FE NM
87505-7674
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8749
  • Fax:
Mailing address:
  • Phone: 505-989-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH2543
License Number StateNM

VIII. Authorized Official

Name: JOYCE HORN
Title or Position: DIRECTOR
Credential: MS, RDH
Phone: 505-989-8749