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General NPI Number Information
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NPI Number | 1104377811
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Entity Type | Organization
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Legal Business Name | BECKLAND DENTAL KIDS OF FARMINGTON LLC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 3903 BECKLAND DR
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City | FARMINGTON
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State | NM
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Zip | 87402-4701
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Country | US
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Telephone | 505-436-2735
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Fax | 505-436-2735
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Provider Business Mailing Address
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Address Line | 3909 BECKLAND DR.
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City | FARMINGTON
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State | NM
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Zip | 87402
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Country | US
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Telephone | 505-436-2735
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Fax | 505-436-2736
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | LISA HODGES
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Credential |
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Telephone | 505-787-2965
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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 | DD2872
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD3385
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License Number State | NM
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