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General NPI Number Information
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NPI Number | 1013404581
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Entity Type | Organization
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Legal Business Name | NEW MEXICO DENTAL CLINICS LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1594 SARA RD SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124
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Country | US
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Telephone | 866-851-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 1594 SARA RD SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1860
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Country | US
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Telephone | 866-851-6236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE HANNA
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Credential |
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Telephone | 505-273-3220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD4651
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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