Healthcare Provider Details

I. General information

NPI: 1518771971
Provider Name (Legal Business Name): SILVER SKIES DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 E PINE ST
SILVER CITY NM
88061-7155
US

IV. Provider business mailing address

PO BOX 344
HIGLEY AZ
85236-0344
US

V. Phone/Fax

Practice location:
  • Phone: 575-342-4546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA BENSON
Title or Position: OWNER
Credential:
Phone: 801-927-8711