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General NPI Number Information
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NPI Number | 1336505916
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Entity Type | Organization
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Legal Business Name | CLOVIS FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2000 W 21ST ST STE L1
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City | CLOVIS
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State | NM
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Zip | 88101-1400
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Country | US
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Telephone | 575-762-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 W 21ST ST STE L1
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City | CLOVIS
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State | NM
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Zip | 88101-1400
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Country | US
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Telephone | 575-762-8000
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JULIE D BRIDGES
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Credential |
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Telephone | 575-356-8514
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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 |
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License Number State |
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