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General NPI Number Information
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NPI Number | 1184968992
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Entity Type | Organization
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Legal Business Name | THIRTY-TWO PEARLS SMILE SPA
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 114 W FOX ST
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City | CARLSBAD
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State | NM
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Zip | 88220-6212
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Country | US
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Telephone | 575-236-1001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3087
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City | CARLSBAD
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State | NM
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Zip | 88221-3087
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Country | US
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Telephone | 575-236-1001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JOANN JODY MCCAULEY
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Credential | R.N. R.D.H
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Telephone | 575-236-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DH1521
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License Number State | NM
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