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General NPI Number Information
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NPI Number | 1538416854
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Entity Type | Organization
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Legal Business Name | DARMITZEL ORTHODONTICS, LLC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 11/16/2014
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Provider Practice Location Address
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Address Line | 400 KIVA CT STE A
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City | SANTA FE
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State | NM
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Zip | 87505-5878
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Country | US
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Telephone | 505-982-6656
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Fax |
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Provider Business Mailing Address
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Address Line | 400 KIVA CT STE A
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City | SANTA FE
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State | NM
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Zip | 87505-5878
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Country | US
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Telephone | 505-982-6656
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. STEPHEN E DARMITZEL
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Credential | DDS, MS
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Telephone | 505-982-6656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DD3490
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License Number State | NM
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