Healthcare Provider Details

I. General information

NPI: 1336075704
Provider Name (Legal Business Name): PURE HYGIENE DENTAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PASEO DEL PUEBLO SUR
TAOS NM
87571-5997
US

IV. Provider business mailing address

PO BOX 2971
RANCHOS DE TAOS NM
87557-2971
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-8722
  • Fax:
Mailing address:
  • Phone: 575-779-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: KENDRA B ROMERO
Title or Position: DENTAL HYGIENIST
Credential: RDH
Phone: 575-779-8722