Healthcare Provider Details

I. General information

NPI: 1265004790
Provider Name (Legal Business Name): FRANKLIN DENNIS BARDIN CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PASEO DEL CANON W STE A
TAOS NM
87571-6943
US

IV. Provider business mailing address

105 PASEO DEL CANON W STE A
TAOS NM
87571-6943
US

V. Phone/Fax

Practice location:
  • Phone: 575-737-5533
  • Fax:
Mailing address:
  • Phone: 575-737-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: