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General NPI Number Information
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NPI Number | 1497254825
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW DENTAL RUIDOSO
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 11/30/2018
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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 | 88345-6942
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Country | US
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Telephone | 575-257-9053
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Fax | 575-258-1194
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Provider Business Mailing 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 | 88345-6942
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Country | US
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Telephone | 575-257-9053
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Fax | 575-258-1194
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHANA L. MUNOZ
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Credential |
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Telephone | 575-257-9053
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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 | DD3694
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License Number State | NM
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