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General NPI Number Information
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NPI Number | 1255814968
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Entity Type | Organization
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Legal Business Name | SOCORRO DENTAL CARE INC.
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 1594 SARA RD SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1860
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Country | US
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Telephone | 877-989-7413
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Fax | 505-226-9697
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Provider Business Mailing Address
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Address Line | 1594 SARA RD SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1860
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Country | US
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Telephone | 505-273-3220
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Fax | 505-226-9697
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE HANNA
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Credential |
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Telephone | 505-273-3220
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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 |
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License Number State |
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