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General NPI Number Information
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NPI Number | 1174956676
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEW MEXICO DENTAL GROUP PC
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 2455 S. TELSHOR
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City | LAS CRUCES
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State | NM
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Zip | 88011
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Country | US
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Telephone | 575-522-0454
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Fax | 575-522-3472
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Provider Business Mailing Address
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Address Line | 2455 S. TELSHOR
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City | LAS CRUCES
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State | NM
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Zip | 88011
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Country | US
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Telephone | 575-522-0454
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Fax | 575-522-3472
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERTO BOBBY ESPINEZA
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Credential | DDS
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Telephone | 575-382-2054
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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 | DD3462
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License Number State | NM
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