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General NPI Number Information
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NPI Number | 1104939073
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Entity Type | Individual
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Provider Name | ROBERT ANTHONY FILICE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2019 GALISTEO ST H-3
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City | SANTA FE
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State | NM
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Zip | 87505-2106
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Country | US
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Telephone | 505-471-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MANZANO LN
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City | SANTA FE
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State | NM
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Zip | 87508-8214
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Country | US
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Telephone | 505-466-1438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1554
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License Number State | NM
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