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General NPI Number Information
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NPI Number | 1316802366
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Entity Type | Individual
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Provider Name | IVAN LOUIS MUNOZ RDH
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Gender | Male
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 127 EL PASO RD
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City | RUIDOSO
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State | NM
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Zip | 88345-6033
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Country | US
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Telephone | 575-257-9053
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Fax |
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Provider Business Mailing Address
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Address Line | 2443 WYATT WAY
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City | ALAMOGORDO
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State | NM
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Zip | 88310-3706
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Country | US
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Telephone | 575-214-7627
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH5331
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License Number State | NM
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