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General NPI Number Information
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NPI Number | 1245599653
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Entity Type | Individual
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Provider Name | DIEGO ERNESTO HURTADO D.D.S., M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1645 GALISTEO ST
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-984-0694
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Fax |
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Provider Business Mailing Address
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Address Line | 2948 DURANGO DR
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City | SANTA FE
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State | NM
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Zip | 87507-4886
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Country | US
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Telephone | 505-250-1167
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DD4927
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License Number State | NM
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