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General NPI Number Information
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NPI Number | 1457278640
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Entity Type | Organization
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Legal Business Name | ON THE CUSP DENTAL STUDIO, LLC
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 200 MANZANARES AVE E
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City | SOCORRO
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State | NM
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Zip | 87801-4215
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Country | US
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Telephone | 575-835-3662
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Fax | 575-838-1631
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Provider Business Mailing Address
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Address Line | 200 MANZANARES AVE E
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City | SOCORRO
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State | NM
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Zip | 87801-4215
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Country | US
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Telephone | 575-835-3662
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Fax | 575-838-1631
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN B WAITES
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Credential | DDS
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Telephone | 509-750-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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